Study Syllabus for Classification of Radiographs of Pneumoconioses

DRAFT DOCUMENT

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Pathology Overview

Pathology Basis of Occupational Lung Disease

Coal Workers’ Pneumoconiosis

Associated Lesions: Emphysema and Diffuse Interstitial Fibrosis

Inhalation of coal mine dust has been determined to be an independent risk factor in the development of emphysema.6,10,11 Progressive centrilobular emphysema constitutes an extension of focal emphysema associated with the coal macule. Panacinar emphysema represents a less common variant associated with coal dust exposure.

In a study that evaluated emphysema severity in whole-lung thick sections from autopsies of 722 US coal miners performed from 1957 to 1973, Kuempel et al found that emphysema was significantly elevated in coal miners compared with no miners among ever and never smokers and that cumulative exposure to respirable coal mine dust and coal dust retained in the lungs were significant predictors of emphysema severity.12

Pulmonary interstitial fibrosis documented at autopsy has been variably reported in the lungs of coal miners in as many as 33% of cases. Interstitial fibrosis may macroscopically resemble honeycomb lung. Histologically, black pigment and mineral deposition in the areas of interstitial fibrosis were noted in 53% of cases (Fig. 31). However, in the remaining 47%, interstitial fibrosis was nonpigmented, resembling the type of fibrosis seen in idiopathic pulmonary fibrosis.13 Chronic interstitial pneumonia and fibrosis resembling usual interstitial pneumonia were also identified in a subset of French coal miners with clinical and radiologic evidence of interstitial lung disease with honeycombing.14

Page last reviewed: August 9, 2019