Silicosis

Sand in lungs is not fun.

Types

  • Acute - Symptoms within weeks to a few years

  • Chronic

    • Simple - Lots of small nodules in the lung on imaging

    • Complicated aka Progressive Massive Fibrosis - nodules larger than 1 cm with strands

  • Accelerated - Overlap with both of the above but rapid over 5 to 10 years

Jobs

Silica exposure comes from coal mining, ceramics, masonry, glass manufacturing, steelworks, quarrying, stone cutting, sandblasting, and tunneling.

Acute Silicosis

  • Rare

  • Exposure to high concentrations

  • Few weeks to a few years

  • Symptoms are rapid shortness of breath, cough, weight loss, fatigue, chest pain, and fever

  • Exam shows crackles in the lungs on listening

  • No blood tests help

  • Lung function tests show a restrictive pattern

  • Imaging shows ground-glass opacities on X-ray or CT, typically on both sides.

  • Washings from a tube down into the lungs show thick, opaque discharge.

  • Treatment is limited

  • Prognosis is poor

Chronic Silicosis

  • Develops slowly 10 to 30 years after exposure

  • Symptoms include chronic cough, shortness of breath on exercise, and sputum production.

  • Blood tests do not help

  • Lung function tests are helpful

  • X-rays show lots of small round nodules.

  • CT not usually necessary unless X-ray shows sinister features

  • PET scan can help differentiate nodules from cancer

  • Tube down in the lungs doesn’t generally help with diagnosis

  • Treatment is limited

Death

  • Average of 12 years of life lost

References