Document gwNzex6pEYzZaJ8pdejORy19

FILE NAME: Sprayed Asbestos (SPRA) DATE: 1962 DOC#: SPRA016 DOCUMENT DESCRIPTION: Medical Journal Article - Radiology of Some Rarer Dust Diseases Scoi. mcd. J., 1962, 7: -178 RADIOLOGY OF SOMK RARKR DUST DISFASFS' (Barvloxis, Axbeslosix ami Sideroxis) ( '. A', iilum Chest C'linu-., V k Io ii .i llospit.il. (iionp, Cl.isgow U NI i k i gas and vapour, dust and fumes are composed ol panicles winch aic in haled into llie lungs. Dusts are panicles oi aggregates ol panicles of I to 150 microns in diameter. Fumes are of the si/e of 0.2 to 1 micron. Smoke is less than 0.3 mica on in diameter. Gases and vapours include simple asphyx iants, chemical asphyxiants, irritant gases, organo-metalhc gases and anaesthetic vapour. Fog and mist are essentially liny liquid droplets condensed abotit solid panicle-, such as cai bon. as a nucleus. I he defence--, against dust or fumes aie: (I) Nasal defence with its mucous sccietinn, (2) ciliaiy action of nasal and bionchial epi thelium; and (3) the phagocytic piopeilics of cells. As the aveiage si/e of dust particles is up to 5 micions. a great number of particles can get into the king alveoli, which measure about 100 microns in diameter. The limiting factor of dust particles found in the lung is the diameter of lymphatic channels and not the alveoli. The amount of dust, the type of dust inhaled and the individual susceptibility dilfer considerably in dilferent individuals. Dust may be organic or inoigamc. In organic dust may be; (1) Inert or non-prolileratise dust; and (2) active or proliferative dust. Mixture of (1) and (2) results in a modi fied proliferative reaction, which is further modified by infection with resulting inllammalion and emphysema. Inert dust does not produce a specific reaction in the lungs. Active dust is aggressive, producing reactive and proliferative changes in the lymphatic, vascular and parenchymatous pattern. >Hasoil on a lecture delivered at the meeting of the Scottish Radiological Society on 24th I ehruaiy 1967 '1 lie icsiili ol piolonged inhalation ofnI ei.tl dusts, such as those of granite, flint, 5ta,j and .isbestos. is a icactise state of the lug# tissue comprised in the generic terra 4* *, pneumoconiosis It descnbes at times pul monaiy fibroses. which result from the ini* lation of noxious or innoxious dusts, whim a are dilferent mixtures of substances in whji ** dilferent pathogenicity determines the O Vl come of resulting lung changes. Manyofthtfi fc lung changes are scarcely to be considered* lung diseases; they may exist without imps* ing physical ellicicncy; they have been terras: benign pneumoconiosis (anthracosis. xiden sis, chehcosis). On the other hand, dust a* mining a high concenti ation of silica prodas moie or less xenons forms of pul mom; changes of considerable medical andeiee*j mic impoitance (malignant pneumocow* sis). Admixtures of alumina, carbon, gypsosand hematite result in a temporary or pe manent modification of the reaction toll, silica content of the inhaled noxious mattni retarding or inhibiting its deleterious effect!* alveolar lung tissue, 'finis silicates vrgreutly in their pathogenicity; some arcnctfV completely inert or mildly noxious, ollieis may even be seen producing a retard^ eifect upon the action office silica. AsarsSt the inhalation of organic dust produce* to pneumoconiosis. Inhaled particles of 10 microns or lessi t phagocytosed and carried through pulmowjlymphatics into the regional peribronett1 and hilar lymph nodes. Prolonged exposure! high concentrations leads to accumulation/ the lymphatics sin rounding the pulmontj vessels. 1 hese deposits are seeen in the X-n* pictme if the mateiial is radio-opaque-a# sidciosis, baiytosis and anthracosis, Itadiology ol Some Um cr Dust Discuses TS* Itble I. Intel national classification of pci cistern iadiologic.il opacities m the lung held-, pioiokvd In the ihalauon of mmeial dust (Cienc\a ( ie.nion l`)5X') No pneumo coniosis Suspect Pneumoconiosis Type of opacity 1 mcai opacities Small opacities , l.aige opacities Qualitative features 0 7 P in 11 a nc Quantitative od inhalation of min- features I 23 2 3 12 3 of granite, Hint, sand Additional .i\ e state of the junt symbols (co),'(cp) (c\) (di) (cm) (hi) (pi J (px) lib) he generic term of Including coal and eai bon dusts. ciibes at times pulresult from the inha- The object of the classification is lo codDiefyhnIihlieoni.sidaionldogciocmalmaepnptsoaiances of the pneumocoiiioses in a simple, noxious dusts, whict asily reproducible way. It is intended lo dcsuihc die radiogiapluc appcaianccs of die peisistent opacities l substances in whicl issociated with pneumoconiosis, not to delme pathological entities, noi to lake into account the question of determines the out- working capacity. Where there is an appreciable dilference in the appearance of the two lungs, the two appcaianccs may bc lianges. Many, of these kjcribed separately, beginning with the tight lung. U to be considered at exist without impairlley have been termec tanthracosis, sideroiher hand, dust con.ion of silica produce arms of pulmonar* medical and econo mint pneumocon la No pneu> moeoniosis Suspect opacities . Linear opacities 0 No ladiogiaplnc evidence of pneumoconiosis 7. Incicascd lung nun kings Pneumoconiosis L Numerous Iiikmi oi ictictiKu opacities, the lung patlcm hemgnoimal accciitualcd ot obscuied I lie lollowing types aie defined according to the gicutest dianietei of the ptedominanl opacities I lie culegoii/alion depends on the extent and the piolusion of the opacities mia, carbon, gypstm t temporary or peti the reaction to tbs led noxious mateiii deleterious effects os I Inis silicates vat) icily; some are near!; iIdly noxious, whifc producing a retardinf i ft ee silica. As a rule nc dust produces tw Small opacities p Punctifoi in opacities, Si/e up to 1.5 nun m Micro-nodului or initialy opaci ties (.neatest diameter between I 5 and 3 mm n Nodulai opacities Si/e between 3 and 10 mm Cat. I. A small numbei ol opacities in an atea equivalent to at least two anienoi rib spaces and at the most not gi eater than one-thud of the two lung fields. Cat. 2. Opacities more numerous and dilluse than in Cat. 1 and distributed ovei most of the lung fields. Cat. 3.Veiy nunicious ptofusc opaei-. lies coveting the whole or neatly the whole of the lung fields A An opacity having a longest diameter of between 1 and 5 cm or seseral opacities each gi enter than 1 cm , the sum of wlune longest diameters does 0 microns or less an not exceed 5 cm d through pulmonary t, Large \ opacities B One or mote opacities, larger or more numerous than those m Cat A. who-e combined area does not exceed one-third of one lung field gional peri bronchi*' C One or mote huge opacities, whose combined aiea exceeds one-tlurd of i't olonged exposure U; one lung field. 1- to accumulation it Additional symbols. (eo) abnormalities of the cardiac outline To be replaced by (cp); cor pulmonale, it this condition is iding the pulmonary i strongly suspected. ue seeen in the X-m (cv) cavity. (di) significant distortion of the mtr.i-ihoiacic oig.ins . ladio-opaque- as ft - (ein) maiked emphysema (p|) significant pleural abnomialities. (In) marked abnomialities of the hilar shadows (px) pneumothoia.x. .inthracosis, (tb) opacities suggestive ol acm e lubciculosis. 1. The choice of order of the symbols is left lo the convenience of the physician 2. T h e b a c k g r o u n d o f small opaci t i es s houl d be specified as j ar as possible I ^ ; t i <1 r j m if Up " lY> Blunt The merits of classification of dust into different types are debatable, i ^ ^ u d o nical description is impoilani, and should be as accurate as possible, taking into'.account the anatomical lung system, including hila, bronchi, alveolar struciu.e, pulmonary vas cular texture, especially artenal pattern thoracic deformity, pleural involvement (such as in asbestosis) a n d eaidiae con silico-tuberculosis, of boiler scaler lungs, ani of Kaplan's syndrome in coal miners. In add*turn we have examined a considei able nunthet ,,C patients exposed to different types of dust and found seven cases ot barylosis (related by Or A. T. Ooig), four cases ol asbestoux and thirteen proven cases ol siderosis sidero-silieosis, amongst 15,000 cases of non- tubeiculous chest diseases. tours, with special relation to right ventrieulai enlargement and features ot i<>> pu iho/hi i- Barylosis (7 cases). This condition due to inhalation of baiiunt dust, is generally dawr The Geneva classification of 1958, appli cable to all dust diseases, has superseded a previous descriptive and clinical turns o .c u. inhalation diseases, and should be accepted as standard description. This is described m Table 1. The radiological terms applied to dust diseases refer to the appearances: ol linear or reticular opacities; punctiform opacities (1 5 mm. in size); micro-nodular or miluuy opacities (1.5-3 mm. in sue); nodular opaci ties (either single or multiple, having diame ters of 1-5 cm.), which can be easily differ entiated against the early appearance of sus lied as an inert dust disease (bigs. 1-5). Mott of the leports of this condition come fros Italy; they are confined to clinical and radio logical aspects and do not include patholopcal findings. The affected men have been eftgaged in mining, sorting, grinding and bagginj j the ore barytes (BaS04) under condition* which exposed them to very high concenlralions of dust. The most intense dust cloud* wcie found at grinding operations and me*sines of suppression were inadequate entirelv lacking. Fig. 2 - HarytoM (Ijspnoea. 1 hii u medical change pected inhalation disease, in which only increased lung markings aie found. The uniform acceptance of the Geneva terminology (1958) would dearly obviate the radiological classification ol reticulation o pinhead mottling, nodulation, co^ewen nodulation . with development of massive shadowing and multiple which has been hitherto applied to the classi fication of pneumoconiosis m coal minets, or supersede the classification for pure silicosis of Stages I, 11 and 111. It would compr.se the classification of Sampson (1955), ^ al. (1951) and Cole (1946), which tsembodted m the additional symbols, usefully applying clinical manifestations anti features. The essentials to the diagnosis of dust dis eases are an exhaustive occupational histo y with regard to the exposure to dust, fumes gases and vapours, and a good radl0J?8l" picture of the lungs. T h e oecupattona! history should cover the patient's whole life,.and the length of employment m different jobs, clinical findings are sometimes negligible Our material seen in the chest clinics of the Victoria Infirmary Group in the last few year covers a fair number of pure pncumocomi oses of coal miners, cases ol pure silicosis and ... i n.rviosis Ci W., aged 26 years. Morn*, cough; no'dyspnoca, no sputum Hive years'e x p \ eaily changes. Fig. 3. Baryu'-ii M ** N v ^ i ;. : ;^.> Ka d i u l o p ) u| S o i m I'.11 i i | ; u `)l 1>1^1 .i^L ^ . Fig. 2. HaiWosis \V S , .igcd 31 \l j i s C nuph no J\'pnoei I In 1 teen >e.u V i \(h n i k - IiKUl.iI lIuiii-'l', \s ide-,pi v. ,td v> mi ftg. 3 H.i 1 ylosis W S , i a l c i u l \ i cu F S. lidi y (os k >\ S , a g e d 30 _\i_.iis N o loim-jIi , n o ' ' Pnuhi 1 no J>s|>nocd. S e \ e n ) lji ' l \ pomiil uMen- mu mii'w llaU nppLdiaiko Ilium I hr In -.1 c use w j s dc'su ihed In I mi i I I9 'S i in a man who had been e mpl o y e d loi 27 ' yam m a hin \ /iw mill. hut. m addition to mai kcd .Vine changes with noduhu shadowy ol dm M/o o f a pea. this man c ompl ai ned ('I w e a k ness. i oimh maiked dyspnoea on exeilmn and n o asmnal attacks of anpina pectoi is I Ik s Im k a I and i ad ml epical pic tin e was, thei eloi e \ e i \ suggestive ol silicosis, although the d y s pnoea could have been eaidi ac in ongan .Subsec|uenl wnleis , howcnei, make special mention ol the tnvial natuie of' the clinical I'1' t u n . in spit! o| well-marked ludiolopical c lianpe, Ai i mom ( I9 7 1) cays that t his (y pc of p n e u mo c o n i os i s is c hai actei i/cd by a mal ted contiast between the benign subpein e and o h | ( c to e c 11meal sy mptonm (oi c >, n b e n entile a b a nee), and the gi a' i t y of the i idmlopical picl tue, 1'ieti and dall mi (19 IS) md S pe d i n i and VaUlini (1939) make siimlai s l il emen ts I he lattci obsei veis numlion a di mi nuti on <9 the ladiological abnoi mahties yy he n t he yyoi kei hsi \ es tlie d list \ c m ii onmcpi 1 he c o n d e m n of bam Ios is does not s i m lo i . \ a m is m e a d teinlc in y lo tllbe Iulo a ia dc d I ' m i I'>n, i ,i< i ua Ib l y o n c k o win Ili i il m ie h I noi ., n e \ n l a p i o t o l i w r I mi i mi in si Ih a ; d i ' i a a I he me idenc a ol ami ; (mi l l s ol Inn" n 1' . i o n sin h as pneumoni a h m m e i . y n M o l y hi eh ( a mba ( I9 ' I i a bo b mn d tallnn a hieli me idence ol p!c m o I'M'III ha pi i l ni ai i an al l ci t i ons . ai I n c oi In ib cl. on V i n e c s a m ma l m n ol l o m h e i i Sai dmi an mme i s l i e did not l egai d 111 se as bi si" i el.Ued in m c upati on / y/ h i m u in n! siii hi y k i n g o m ( | 9 t t ) a n - m . dm! in pi oduc mg n o d iilation in \ lay hI nm "I ''innea-piia and i dibits sub|eeled lo dm in ''a hi Iion a nd mu i<i ac heal in p c Iion ol /w l 'ey dust I Iml. |!| line ally . lie spe ;i t s ol lie, b mu as a dn ,1 in i nul o o s' lalhei than a pm e nn a on lot k noil ihi a 11hong h Ik dc c Iin U' e-, po Ss an iipimon on the ultimate and P" '-ilslm hbi on , 11a n d oi ma Iion ol tin pi a 1111 hmia I In. ml; n a i ipac 11y ol the nodules m \ lays is c ommentc d on by ya i ions w 1111 i and I' mchei i (|9Si) h) i oni hides dial b 11 yIo a - k a pneu ii'o hiikms ol a Ik m "a 1 h 11 ac tei winch (an hr i eadily d 1st iii ein'li. 11 d om -aIii o- m m dial I I) the i ad log i a ph i. cb Ogees may appeal altei only a fewy months' i ' posn u (' ) lie i nml ii mu does not c a use deat h. ( ' ) llieie m io he e p e u t a"i'm,e.' \y ith Iulieic ul oai s, and (4) the \ - i a\ \ unk>. di mmi s h on i c m o v a 1 o f the suh|eet ti anu posui e to dust h u u lcn ir anil inla'inn in \<ln.n\i\ k o e has been dcsci i bed in Cueat Hi man m fa., is known, but i cf ei eucc to die coikIiI link, been made in the I hilled States by Pendergrj(1942) and IVndei gi ;ss and I eopol d '194' yylio also l egai d it ;m a foi m ol bemen price mo e o mo s i s Al t houga most if the icjnrtss (he h l e i a t me on t i e pneammai nn 'is . ha i mm wot kci s m die ate Ihat die com. lion a b e me n one it mu d not be f omoi t ni l ; the w o i k e i s may be exposed lo sdua d.tdei i yed licmi t l i c o i e In '(mik aieas e indm m p i i l o i m e d bel wce i mi ll stones \. h Ji is t hcni s ehes highly s i l c e o u s md which vue down i .1 p icl Iy in use dai s c on 111 hui mi loir silica c'cmtent o f the Insi ( l ) oi g, 1956). Aslirslosis (4 cases) I Ins lie' been o d c i . t m asbestos yyoikeis a'besi is heme a b di ited maei ms i um 'll cate, iis.d m die mmK lac t ii m o| a d'e 'i (>s i. p|i and n i aei \i 11 ,. dl l ) l i p (>. \ s l i t > ! i " . i s \ H U N cl M ' o i 1 '- shp's't U ( H I- d l I I >' I n \ t J I ^ ( 1 X' d l k 0 K n y` ,111 I y` )' I d t ' H e Ii I * I n t I H I ( . 1- I 111! cl v s ' n m \ l p p m |p c- - n ] r |. h n i p o f 1111i ' i i d k \ ,i h o m J j n s i ' o si t ! (> M i n M U [ k I V " , n ! ' i W I MP. ck I c ' k N p ! C , i c i |( M P . I f p k'M I .11 IH ' o ik L'M k'lil ilatei al c n i n g , pleui o,s. The me ill- -diaggy a'lll aic lounii ^ally in !^d an,1 pci i ,ic less l o o in due to >a kel 11e o in six noncu y 'h illary ,on of ol \a v mid he matoid a Klell ! ,,/ nul . nnsoli- iu Iy , a ud due , \i Inch me to a ,0 Cape R a dioing <>l linin' R a m Duel Diseases l i ^ . 14. U lio p a lh ic |H i Ii i h u u i \ h.u. nio-suk i o m -> I K .irct.1 (>N _\u u x I \ |)K 11 m ill a i \ p m la .id i it " Uil.itiun lleOUIlmlders, \ e Iders, i silver i etieu- md the <V 13) lopathic ml dust ures ai e Imp read .dcd ap- I Kg. 13. Sideiosilicosis I tl , aged U> \eais I leeiiic t welder (in loundnes) loi 30 seals Well developed 5 sidemsis with Modulation I'.Uiem espomd lo mine I illie.l i k e ' UUeeel 0) OtllU s'*"I kill11_n H g . 15. I d i o p a l l u e p u l mo n . i i > l i aei nosi dei o is M D , aged 20 veals Aeule liaenioljOe phase Radiology (if Mime Rarer Dust Discuses KI M R l n c | s a r r u , o N i, \. (19.13) I a pncunioconiosi da h.u m Med. iI. I.aroro, 24, 461 C am ii a, R. (1951) C'onliibuto alia cimoscen/a dcll'a/ionc delle p o hen di haiilc sull'nomo Met! d. I uvoto, 42, 221 C O C I I R S N I ' , A, | I) A V I I S, I | | I I < II 1 K, c. M. (1951). Interne rndiologique; step tow.uds international ttgieemein on classification of udio- giaplts in pneumoconiosis. Rut. J indiisli Med 8, 244 ' C O L L , L. g . (1946) Pneumoconiosis In ( him id imho- logy, edited by G U Pillmoie Vol I Philadelphia Davis o a v i l s , c. N.ed (1961) Inhaledput tales and\a/>om s Proceedings of an International Symposium oi - ganised by the British Occupational llyaicnc Society. Oxford: Peigamon Press ' DOIG, A T. (1950) Iron in the lungs Arch helves Med. sue,, 8, 442 d o i g , a . t . (1956). Dust diseases, excluding hbioik pneumoconiosis, in Indiisli tal niethtine am i hveiem , Vol. Ill, edited by P. k. A Meiewethei p' 121 London: Butteiwoith & Co I I Cl, i.. (1938). Pneumoconiosis. In Occupation and health. Geneva: International Laboui Otlicc FI O K l, (1938). Pneumoconiosis In Occupation ami health. Geneva: International 1 abour Oliicc H I C K S, D. I A V, J W. J. A S II 1 O K | ), j . K K v s (1961). The relation between pneumoconiosis ami ensiionnienlal conditions London. National ( oal Boaid. il n it vv l I / , \i (1961) Roe nt ge nol ogi c aspect s o f a-bcslosls Anni / Rinnleenol, 85,256 M l N l s t i n i i i n m i it ( I960) Da-est o) pneanioloniosis statistics I oiulon II M Stalioneiy Olhce OKI NS I M n , 1 I ed (I960) 1`io iccd in c.s u lih e p iiei,- niot onnisis t o n / n e n t e held at Ihe Umt ei si ly of Wilwaleisiaiul, Chuichill lohanneshuig, ' I9s9 lomloir l` \ N t ii i it i, i, ( 1950c/) Su al cune l o i m c til pnet o mocomosi pai ticoLu inente suuliatc in Italia (tio-pneumoLoniosi e haiitosi) \lctl d lusoto iI 1 1 ' r a N c ii i it i, <,. ( I9s()/i) L 'a s p n a / i o n e delle p o h e n 111 m i m e i a con I u p p a i e c c h i o Hoi s. i u Russ. M ed indiisli , 19, 2 I 7 a i N i) t it i, it a s s, l i- (1942) S o m e co n s i d er at i o n s concerning the loentgen diagnosis of pneumoconio sis and silicosis Imei J Roentgenol 4 8 , 571 e i n i) i it t, it a s s, i . i- i i o i - o i d , s s. (1945). Benign pn c u mo n o c o n i o s i s ./. lin e /. metl lit 127 701 ' ' |J u i i i, l l a i i i n i, i- t (1919) Repot t of Hth Intel national (o n tn ess on Indiisli nil Undents ami Occupational Diseases I c ip / ig . I Inenie S A M P S O N , Gl t cd 1>> s i l l i> m i n i , s j (1955) Diseases o f the l ungs In O sf o i d meda me, Vol 2, p. 116 O x f o i d l Ji ii \ c i s 11y P a s s ' s P l i) i n l, i v a i ii i r, i, i-. i (1939) C o n t r i b u t o alia studio della pncumoconiosi da haute Radiol nieil ( /in intii, 26, I v* 487 i