Fibrose maciça progressiva em trabalhadores expostos à sílica: achados na tomografia computadorizada de alta resolução

Cross-sectional imaging review of common to uncommon lung cancer mimickers in a tertiary care oncology center

Lung cancer is the most diagnosed cancer worldwide. Many non-malignant pulmonary lesions, such as tuberculosis, fungal infection, organizing pneumonia, inflammatory myofibroblastic tumor, and IgG4 disease, can mimic lung cancer due to their overlapping morphological appearance on imaging. These benign entities with minor differentiating imaging clues may go unnoticed in a high-volume cancer institution, leading to over-investigation that may result in repeated biopsies, pointless wedge resections, and related morbidities. However, with a thorough medical history, laboratory diagnostic work-up, and careful analysis of imaging findings, one can occasionally restrict the range of possible diagnoses or arrive at a definitive conclusion. When imaging features overlap, image-guided lung sampling is crucial since histopathological analysis is the gold standard.

Silicosis and tuberculosis: A systematic review and meta-analysis

INTRODUCTION

Silicosis mostly happens in workers with high silica exposure and may accompany the development of various diseases like tuberculosis, cancer, or autoimmune diseases. The term silico-tuberculosis describes a condition in which an individual is affected by both silicosis and tuberculosis at the same time. This systematic review and meta-analysis study was conducted to evaluate the risk of tuberculosis in silicosis patients and individuals exposed to silica dust.

METHODS

We performed a systematic search for relevant studies up to 6 September 2022 using PubMed/ Medline, and Embase with the following keywords in titles or abstracts: "silicosis" OR "silicoses" OR "pneumoconiosis" OR "pneumoconioses" AND "tuberculosis". Cohort and case-control studies containing relevant and original information about tuberculosis infection in silicosis patients were included for further analysis. Pooled estimates and 95% confidence intervals (CI) for the relative risk of tuberculosis in individuals with silicosis compared to those without; these were evaluated using the random effects model due to the estimated heterogeneity of the true effect sizes.

RESULTS

Out of 5352 potentially relevant articles, 7 studies were eligible for systematic review, of which 4 cohort studies were included for meta-analysis. The total population of all studies was 5884, and 90.63% were male. The mean age of participants was 47.7 years. Our meta-analysis revealed a pooled risk ratio of 1.35 (95%CI 1.18-1.53, I ²: 94.30%) which means an increased risk of silicosis patients and silica-exposed individuals to tuberculosis infection.

CONCLUSION

Silicosis and silica dust exposure increase the risk of tuberculosis. Therefore, we suggest that individuals with long-time silica exposure, like mine workers, be routinely considered for both silicosis and tuberculosis screening programs.

Comparison of the International Classification of High-resolution Computed Tomography for occupational and environmental respiratory diseases with the International Labor Organization International Classification of Radiographs of Pneumoconiosis

The International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases (ICOERD) has been developed for screening and diagnosis of occupational lung diseases. We evaluated the association of icoerd with the International Labor Organization (ILO) classification and respiratory functions in pneumoconiosis. Chest x-rays of patients with pneumoconiosis were classified with ilo and icoerd using hrct, irregular opacity, pleural pathology, and emphysema was detected in 78, 19, and 53 patients, and using chest x-rays in 47, 4, and 14 patients, respectively. There was a significant correlation between ILO categories and ICOERD grades. There was a negative correlation between ILO categories and FEV1% and FVC%, whereas, ICOERD grades were not correlated with FEV1% and FVC%. HRCT was superior to chest x-rays to detect pneumoconiosis in early stage, but not in evaluating pulmonary functions.

Usefulness of occupation and industry information in mortality data in South Africa from 2006 to 2015

BACKGROUND

There is no population based occupational health surveillance system in South Africa, thus mortality data may be a cost effective means of monitoring trends and possible associations with occupation. The aim of this study was to use deaths due to pneumoconiosis (a known occupational disease) to determine if the South African mortality data are a valid data source for occupational health surveillance in South Africa.

METHODS

Proportions of complete occupation and industry information for the years 2006-2015 were calculated for working age and retired adults. Deaths due to pneumoconiosis were identified in the data set and mortality odds ratios calculated for specific occupations and industry in reference to those who reported being unemployed using logistic regression.

RESULTS

Only 16.1% of death notifications provided a usual occupation despite 43.1% of the population being employed in the year. The MORs for occupation provided significant increased odds of pneumoconiosis for miners (9.04), those involved in manufacturing (4.77), engineers and machinery mechanics (6.85). Along with these jobs the Mining (9.8), Manufacture (2.2) and Maintenance and repair industries (6.0) have significantly increased odds of pneumoconiosis deaths. The data can be said to provide a useful source of occupational disease information for surveillance where active surveillance systems do not exist.

CONCLUSION

The findings indicate valid associations were found between occupational disease and expected jobs and industry. The most useful data are from 2013 onwards due to more detailed coding of occupation and industry.

Risk factors and control strategies for silicotuberculosis as an occupational disease

Silicotuberculosis is critical in community settings among workers and employees exposed to silica dust. Older age of entry (>30 years), male sex, infection with human immunodeficiency virus (HIV), exposure duration, smoking, chronic obstructive pulmonary disease, migration, the severity of the silicosis and the intensity of the exposure are potential risk factors. Lack of timely diagnosis and treatment for tuberculosis (TB) may also raise the rate of infection; previous treatment of TB is possibly associated with the development of silicotuberculosis in more than half of patients, increasing with age (>40 years). Identification of risk factors benefits not only the academic research community, but also the workers or employees and policy making. Some strategies can be implemented, such as controlling or reducing exposure to silica dust, ensuring continuity of treatment of TB or extended anti-TB treatment, management of the situation by occupational health professionals, prevention of oscillating migration, providing workers with compensation, training and education in occupational health, improving the quality of life of miners and workers, intensive medical surveillance and TB screening in routine health check ups, and policy making for higher immunity to inhibit inhalation of dust by workers or employees.

The Evolution of Silicosis into Massive Pulmonary Fibrosis — Case Series

Silicosis is one of the oldest occupational diseases, known since the time of Hippocrates, and the diagnosis can be established after a latency time of more than 10 years after exposure cessation. In some cases of chronic silicosis, the disease can progress slowly, evolving over several decades, but it can also evolve into massive pulmonary fibrosis, also known as accelerated silicosis. Furthermore, in extremely rare cases, the disease can present a rapid progression into acute silicosis or silicoproteinosis. The present article gives a deeper view into silicosis and secondary massive progressive pulmonary fibrosis, as well as the difficulties encountered in the management of such patients. We present two different but similar cases that underline the importance of a precise diagnosis, pointing out the long latent period after the exposure to silicon-dioxide, more than 15 years in both cases. This accelerated form of silicosis associated with massive pulmonary fibrosis progressed in 2 years into respiratory failure in both cases.

Imaging of Occupational Lung Disease

Occupational lung diseases span a variety of pulmonary disorders caused by inhalation of dusts or chemical antigens in a vocational setting. Included in these are the classic mineral pneumoconioses of silicosis, coal worker's pneumoconiosis, and asbestos-related diseases as well as many immune-mediated and airway-centric diseases, and new and emerging disorders. Although some of these have characteristic imaging appearances, a multidisciplinary approach with focus on occupational exposure history is essential to proper diagnosis.

Nonoccupational anthracofibrosis/anthracosilicosis from Ladakh in Jammu and Kashmir, India: A case series

Background:

Nonoccupational anthracosis and silicosis has been reported from various parts of the world including Ladakh in Jammu and Kashmir, India; however, anthracosilicosis has only been reported in industrial workers till date.

Materials and Methods:

Six cases from the Ladakh region in Jammu and Kashmir, India with similar clinico-radiological-pathological features, i.e., anthracosilicosis/anthracofibrosis have been analyzed. Of these, four were analyzed retrospectively and two prospectively.

Result:

All the patients were homemakers and resided in Ladakh in Jammu and Kashmir, India since birth with an age range of 42–62 years and an average age of 56 years. Their average duration of symptoms was 4 years. Spirometry showed small and/or large airway disease in 5/6 cases. On computed tomography (CT), 4/6 cases showed progressive massive fibrosis (PMF) with calcified mediastinal lymph nodes. There were random or centrilobular nodules in all the six cases. Bronchoscopy in 5/6 cases showed multiple anthracotic pigments with narrowing and distortion of the bronchus (anthracofibrosis). Malignancy was suspected clinico-radiologically in four cases and pathologically in two cases. On histopathology, anthracosis was demonstrated in all and silicosis in three cases.

Conclusion:

Anthracosilicosis can occur due to environmental exposure. Ladakh in Jammu and Kashmir, India is the only place across the globe with unique environmental features having the presence of both free silica and biomass fuel. The disease was observed predominantly in older women. Awareness would prevent unnecessary investigation for malignancy. Treatment with the bronchodilator is useful as it has evidence of airway disease. Finally, environmental measures and a proper study need to be undertaken for knowing the relative role of silica versus soot in causing the lung disease and preventing this irreversible condition.

Thoracic lymphadenopathy in benign diseases: A state of the art review

Lymphadenopathy is a common radiological finding in many thoracic diseases and may be caused by a variety of infectious, inflammatory, and neoplastic conditions. This review aims to describe the patterns of mediastinal and hilar lymphadenopathy found in benign diseases in immunocompetent patients. Computed tomography is the method of choice for the evaluation of lymphadenopathy, as it is able to demonstrate increased size of individual nodes, abnormalities of the interface between the mediastinum and lung, invasion of surrounding fat, coalescence of adjacent nodes, obliteration of the mediastinal fat, and hypo- and hyperdensity in lymph nodes. Intravenous contrast enhancement may be needed to help distinguish nodes from vessels. The most frequent infections resulting in this finding are tuberculosis and fungal disease (particularly histoplasmosis and coccidioidomycosis). Sarcoidosis is a relatively frequent cause of lymphadenopathy in young adults, and can be distinguished from other diseases - especially when enlarged lymph nodes are found to be multiple and symmetrical. Other conditions discussed in this review are silicosis, drug reactions, amyloidosis, heart failure, Castleman's disease, viral infections, and chronic obstructive pulmonary disease.

Silico-tuberculosis and associated risk factors in central province of Iran

INTRODUCTION

Co-existence of silicosis and tuberculosis is known as silico-tuberculosis. This article review the frequency of silicosis and tuberculosis in workers who exposed to silica and evaluate influencing factors that may increase the risk of silico-tuberculosis.

METHODS

An analytical cross-sectional study was performed in silica exposed workers in central province of Iran during 2011-2012. Sampling method was un-randomized and considering all workers who at least 6 months exposed to silica. The study was done via questionnaire, clinical examination, spirometry, chest x-ray and tuberculosis investigations.

RESULTS

A total of 3,121 workers were included in the study, the mean age of participants was 43.1±12.4 years, and mean employment duration 14.9±6.8 years. Prevalence of TB in silica-exposed workers without silicosis was 172 cases per 100 000 people and prevalence in silicosis cases was 917 cases per 100 000 people. Incidence of TB in silica-exposed workers without silicosis was 69 cases per 100,000 people and incidence in silicosis cases was 459 cases per 100,000 people. The frequency of LTBI/TB was higher in age over thirty years old (P=0.02), in workers with employment duration over 10 years (P=0.004), in workers with exposure duration over 5 years (P=0.03) and smokers with over 5 pack-years (P=0.01).

CONCLUSION

Exposure to silica causes a renewed multiplication of bacilli in the healing TB lesions. Prevalence of pulmonary tuberculosis in Silicosis is more common when compared to prevalence in general population, hence all should use prophylactic measures Intensification of work place.

Relationships between the pulmonary densitometry values obtained by CT and the forced oscillation technique parameters in patients with silicosis

OBJECTIVE

To evaluate the correlations between pulmonary densitometry values and forced oscillation technique (FOT) parameters in patients with silicosis.

METHODS

This cross-sectional study comprised 36 non-smoker patients with silicosis and 20 matched control subjects who were submitted to FOT and multidetector CT (MDCT).

RESULTS

Compared with the control subjects, the MDCT evaluation demonstrated that patients with silicosis exhibited greater total lung mass. These patients also had larger non-aerated and poorly aerated compartments, which included nodules and scarring. Compared with the control subjects, FOT evaluation demonstrated that patients with silicosis exhibited changes in both reactive and resistive properties of the respiratory system. In these patients, there was a greater heterogeneity of the respiratory system and increased work of breathing. Significant correlations between non-aerated compartment size and FOT parameters that reflect the non-homogeneity of the respiratory system were observed. The dynamic compliance of the respiratory system was negatively correlated with non-aerated compartment size, while the impedance at 4 Hz was positively correlated with non-aerated compartment size.

CONCLUSION

Patients with silicosis have heavier lungs. In these patients, a larger non-aerated compartment is associated with a worsening of lung function. A more significant pulmonary involvement is associated with a loss of homogeneity and increased mechanical load of the respiratory system. Advances in knowledge The findings provided by both pulmonary densitometry and FOT may add valuable information to the subjective analysis of silicosis; however, more studies are necessary to evaluate the potential use of these methods for assessing disease progression.

Cavitated conglomerate mass in silicosis indicating associated tuberculosis

Silicosis is the most common occupational lung disease worldwide. It leads to respiratory impairment and may have associated infections that decrease pulmonary function. We describe the case of a 55-year-old man with chronic silicosis who presented with hemoptysis and a cavitated conglomerate mass. The final diagnosis was silicotuberculosis.