Document pBY2DQgobdY68M4jGm62z550D

FILE NAME: Sprayed Asbestos (SPRA) DATE: 1962 DOC#: SPRA016 DOCUMENT DESCRIPTION: Medical Journal Article - Radiology of Some Rarer Dust Diseases S c o i. mcd. J . , 1962, 7 : -178 RADIOLOGY OF SOMK RARKR DUST DISFASFS' (Barvtoxis, Axbeslosix mil Sideroxis) ( '. A', iilum Chest Clink-., Vklon.i llospit.il. (iionp, (il.ixgow U ni i l i gas and vapour, dusl and fumes are composed ol panicles winch aie in haled into (lie lungs. Dusts ire panicles 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 micion in diameter. Gases and vapours include simple asphyx iants, chemical asphyxiants, irritant gases, organo-metalhc gases and anaesthetic vapour. Fog and mist are essentially tiny liquid droplets condensed abotit solid panicle-, such as cai bon. as a nucleus. I he defences against dust or fumes aie: (I) Nasal defence with its mucous secielion, (2) ciliaiy action of nasal and bionchial epi thelium; and (3) the phagocytic piopeilies of cells. As the aveiage si/e of dust particles is up to 5 micions. a great number of particles can get mlo the king alveoli, which measure about 100 microns in diameter. The limiting factor of dusl 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 dilfercnt 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 intlammalion 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. >Haxetl on a lecture dclivcicd at the meeting of the Scottish Radiological Society on 24th 1ehruaiy 1967 '1 lie icsiili ol piolonged inhalation ofnI ei.tl dusts, such us those of granite, flint, 5ta,| aoni d .isbestos. is a leactise state of the leu* tissue comprised in the generic terra 4* *, pneumoconiosis It descnbes at times (1 mortal y fibroses, which result from the ini* lation of noxious or innoxious dusts, vshidi are different mixtures of substances in Vital ** dilfercnt pathogenicity determines the Ot Vl come of resulting lung changes. Manyofthiij fc lung changes are scarcely to be considered lung diseases; they may exist without imps ing physical ellicicncy; they have been terra: benign pneumoconiosis (anthracosix. siden sis, chuhcosis). On the other hand, dust a* taming a high concenti ation of silica prodic: moie or less xenons forms of pul mom; changes of considerable medical andeeee*j mic impoitance (malignant pneumocow* sis). Admixtures of alumina, carbon, gypsadand hematite result in a temporary or pe manent modification of the reaction tall, silica content of the inhaled noxious mattni retarding or inhibiting its deleterious effect!' alveolar lung tissue. Thus silicates vrgreutly in their pathogenicity; some arcnctfV completely inert or mildly noxious, olheis may even be seen producing a retard^ elfect 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 pulmostj' lymphatics into the regional peribronefcit and hilar lymph nodes. Prolonged exposure! high concentrations leads to accumulation/ the lymphatics sin rounding the pulmontj vessels. 1 hose deposits are seeen in the X-n* pictme if the matciial is radio-opaque-a# sulci osis, baiytosis ;md anthracosis, kadiulugy ol Sumo U a ic r Dust Diseases TS* Itble I. Intel national ckis.silicalion of pci cistern Kuliologic.il opacities m llic lung holds pimokcd In the ihalation of mmeuil dusl (Ciencsa ( lassilic.mon l`)5X' ) No pneumo coniosis Suspect Pneumoconiosis Type of opacity 1 lllCUl opacities Small opacities , lauge opacities Qualitative features 0 7 Quantitative od inhalation of min- features P I 2 3 in ii 2 3 12 a 3 n c of granite, Hint, sand Additional .i\ e state of the junt symbols (co),'(cp) (c\) (di) (cm) (hi) (I'D (px) (lb) he generic term of Including coal and eai bon dusts. cubes at times pulresult from the inha- The object of the classification is to codDieffyintihtieoni.sulainodlogciocmalmaepnptse.uanccs of the pneumoconioses in a simple, noxious dusts, whick asily reproducible way. It is intended io dcsciihe the radiogiapluc .ippeaianees of the peisistent opacities l substances in whicl issociated with pneumoconiosis, not to ilclmc pathological entities, noi to lake into account the question of determines the out- parking capacity. Where there is an appreciable dilference in the appearance of the two lungs, the two appeaiances may be lianges. Many, of these kycribed separately, beginning with the light lung. U to be considered at exist without impair- No pneu> moeoniosis u liey have been termec Suspect opacities 7. lanthracosis, sidera- iher hand, dust con- No ladiogiapluc evidence of pneumoconiosis Incicascd lung mai kings Pneumoconiosis .ion of silica producet oims of pulmonar* medical and econo nant pneumoconiir . Linear opacities L Numerous lincm oi leticul.u opacities, the lung pattern hcingnoimul accentualcd oi obscuied I lie lollowing types aie defined according to the gieatcst diamctci of the picdomm.ini opacities I lie calcgoii/ation depends on the extent and the piolusion of the opacities iina, carbon, gypstm i temporary or per i the reaction to the led noxious mateiii deleterious effects m I Inis silicates vat) icily ; some are near!; iIdly noxious, whik producing a retardinf i fi ee silica. As a rule nc dust produces w Small opacities p Pnnctifoi in opacities. Si/e up to 1.5 mm m Micro-nodului or initialy opaci ties (.neatest diameter between I 5 and 3 mm n Nodului opacities Si/e between 3 and 10 nun Cat. I. A small numbei ol opacities in an aiea equivalent to at least two anlcnoi rib spaces and at the most not gieater 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 nnineions pi fuse opaci-. tics coveiing 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 gic.uer than 1 cm , the sum of wIhkc longest diameters does 0 microns or less an not exceed 5 cm cl through pulmonary i, Large \ opacities B One or nunc opacities, larger or more numerous than those in Cat A. wlio'-e combined area does not exceed one-third of one lung field gional peri bronchi*' C One or moie huge opacities, whose combined aiea exceeds one-third of i'rolonged exposure U; one lung field. 1>to accumulation it Additional symbols. (eo) abnormalities of the cardiac outline To be replaced by (cp); cor pulmonale, il this condition is icling the pulmonary i strongly suspected. ue seeen in the X-m (ev) cavity. (di) significant distortion of the mtr.i-ihoiac-ie oigans . ladio-opaque- as tt - (ein) maiked emphysema (p|) significant pleural abnoimalities. (In) marked abnoinialities of the lular shadows (px) pneumotlioia.x. anthracosis, (lb) opacities suggestive ol acme uibciculosis. 1. The choice of order of the symbols is left to the convenience of the physician 2. T h e b a c k g r o u n d o f s m a l l o p a c i l i e s s h o u l d be s p e c ifi e d a s j a r a s p o s s i b l e ! |?t1' l- &[ t i <1' f4 !i ll* | T! i1: 11 M*'. Up " i 1"' Blunt The merits of classification of dust into different types are debatable, i ^ ^ u d o cal description is impoiluni, and should be as accurate as possible, taking mto' aecou. t 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) and caidiae con tours, with special relation to right ventrieulai silico-tubcrculosis, of boiler scaler lungs, ani of Kaplan's syndrome in coal miners. In add)' turn we have examined a considei able numho of patients exposed to different types of dust and found seven cases of barylosis (releirci by Or A. T. Ooig), four cases of asbestonx and thirteen proven cases of siderosis sidero-silieosis, amongst 15,000 cases of non- tubuculous chest diseases. Barylosis (7 cases). This condition due to enlargement and features ot i<>> pu mona iThe Geneva classification of 1958, appli cable to all dust diseases, has superseded a previous descriptive and clinical tarns o ,c u. inhalation diseases, and should be accepted as standard description. This is described in Table 1. The radiological terms applied to dust diseases refer to the appearances: of linear or reticular opacities; punctiform opacities (1 5 mm. in size); micro-nodular or miltaiy opacities (1.5-3 mm. in si/e); 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 inhalation of baiium dust, is generally dawr fied as an inert dust disease (bigs. 1-5). Molt 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 en gaged in mining, sorting, grinding and bagginj the ore barytes (BaS04) under condition which exposed them to very high coneentr- j lions of dust. The most intense dust cloud* weie found at grinding operations and mcisines of suppression were inadequate entirely lacking. Fig. 2- UarytoM (Ij'spnoea. 3 Uii u molded change pected inhalation disease, nr which only increased lung markings aie found. The uniform acceptance ol the Geneva terminology (1958) would clearly obviate the radiological classification ol reticulation o pinhead mottling, nodulation, coalmen nodulation . with development of massive shadowing and multiple which has been hitherto applied to the classi fication of pneumoconiosis m coal minus, or supersede the classification for pure silicosis of Stages 1, 11 and 111. It would comprise the classification of Sampson (1955), al. (1951) and Cole (1946), which isembod.ed in the additional symbols, usefully applying clinical manifestations and 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 g d rad'logica picture of the lungs. The oexupattona! history should cover the patient's whole life, and the length of employment in difieren! 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 Fig. 3. Uaryii.-.i i- i n.rviosis ti W., aged 26 years. Mon*, cougli; nodyspnoca, no sputum Five years'expo. J caily changes. II ,-j^' R.i(iiolo^) ul Soim li.im i;ir,i i )ivi .isLs> . Fig. 2. Ha \ losis \V S , aged } \t-ai1-. C ough iid Jv'pnoea I hn tecn \ eai V i \(h n i k \s ide-,pi v.,td v>mi . hld.Ica1lIkui,l'> Fig. 3 Ha i ylOMs \V S , ialcial \ icu Fig- 5. liai >usk >\ S , aged 3() _\i_.iis Nu Luuah, mu *>i> d)s|>noca. Sc\en )eai ' s p o s i n e oiendw Miuw Hake appeaiaike Ilium I hr In -.1 c use \c j s dc' su ibeel In I mi i 1 I9 i in a man who had been e mp l oy ed loi 27 ' yam m a hin \ /iw mill. hut . m a d d i t i o n to m,iikccl ,Viax c ha ng es with noduIni shadowy ol die M/o o f a pea. this ma n c o m p l a i n e d ('I w e a k ness. i oimh maike d dyspnoea on exeilion an d n o a s m n a l a t t a c k s of a n p in a pecloi is I Ik s Im k a I and i .idiolopical pic tin e was, thei eloi e \ e i \ suggestive ol silicosis, a l t h ou gh the d y s pnoea could have been catdiac in oiigan Subseciuent wnleis. houev et, make special me n t i o n cd the t nvi a l n a t u i c of' the clinical I'11 t u n . in spiti o| w e l l - ma r ke d l ad m l o p i ca l c Imogen A i i mo m ( 1 9 m ) says t h a t t Ills |y pe ol p n e i m i o c o n i f n i s is c Imi actei i/etl by a m ailed contiast between the benign suhpei n e a n d ob|e c H\ e clinical sy m p t o i m (oi o a i d r ii e n t i l e a h a nee), a n d the g i a ' i t y o( the i ul ml o g i c a l pie line'. Iheti a n d d a l l m i (19 IS) ind Speehm and Valclmi (1939) m ak e siimlai sl il em enl s I lie latlei obseiveis nie'iilion a d i n u n u l i o n of the i adiological a h no i maht ies w he n t he yyoi k ei lea ye's Ilie d list \ e m 11 o m nen t I he c o n d i1oai of b a n Ios is d o e s not s i m lo ' my a m n r a-a.l teinle in y lo t ube o uh a iode i d I ' i i I I '>i i ,i< 111,111\ yyoncle n w In 11) i U might noi ., n esc i I a p i o t o liw r Imi i 'Si in si Ih a ; d i- ea i I he me idenc a ol . n o ; I n nis ol 11mu n 9 m l um sm li as pn e u nu mi la h r u v e i , n; m, to he hi all ( a m ha ( I9 i1 i a b o b m n d la t l na a l u d i me idenee ol ph m o hi "Hi ho pnl m o n a i y a l l ec t i on s . . n i n e oi h; i k d . on V i a v e x a m i n a t i o n ol l o m t n . n S a i d m i a n m m e i s li e did not legaiel 111 se as bi om i elated in oi i n p a t i on / \/uimuiiml \iii/n\ \ingom (|9 tf) .iu - u a l e l in pi och k mg n od n lat i on m \ i a y h I n n " I ''iiinea-pi'M a a d i dibits sub|ee ted lo dm i " 'a la I m u a m i m u 9 i ae heal in p c I i on ol i n w cl List I b-o 9 o " u al l y . lie spe a f s ol i|a, b i on as a (in ,1 " i i m i l o a s ' l al l t e i t h a n a pm r n i ' M ' i i i n l K n o d i hi a 11h o u r h he eiee I m - t" po w an opinion on the ultimate and P " " lisle- lihi oik 11a m l oi ma I i on ol the gi a n u h m i a I In. ml : n a i p en 11y ol the n o d u l e s m \ l a y s is e o m me n U d on by y a i i on s n u l l o ami I ' m c h e i i ( | 9 s l ) u A h) n u n hides di al b 11 y I o a - k a p n e u m o on u n i s ol a Ik i a " a I b 11 ae tei \s hie h ( a n hr i caclilx d 1st imm win d II o m -alii iw i . mi i ha I ( I ) the i ad log i a ph i. eh Mires may a p p e a l altei only a fewy m o n t h s ' i ' po .a n I ' I iln i o n d il ion does m it c a use deat h. ( ' ) llieie is io l o. ephnl kno u 1. xy11h Iubeie ul o s i s . and (4) the \ - i a\ \ uiek>. di mmi s h on i c m o v a 1 o f the sub|cct ti anu posui e to dust h u u lc n ic mill icla'ion in \'lu o \i\ k o e has been dcsc'iibed in (i i eat Hi man m fV , is known, but l e l ei eaee to the conehl an k been made in the I 'lined States by Pcneiergra(1942) and IVndei gi a s and I copolel 'I94f yylio also legaiel it o a h u m ol bemgn piity mo c o mo s i s Al t houga most if the ie|nrtxs the htcKitme on t i e pneamomKih 'is i hai mm wot kei s indie ate that the com. lion ,i bemni i one il mi nt not he I'oieoi! n tl; the wo i k e i s may be exposed lo sdimi dadenyei l l i o m t l i c o i e In -miiK aicas r inekr i > pmi ot mecl bel wce i mi ll stones \, h Ji theuKel yes highly s i l e e o u s mcl wliieh van do wn lapidly m use 'li in c on 111 hui mi loir silica eonl enl o f the Insi ( l ) oi g. 1956). Aslieslosis (4 eases) I Ins lie-, been o'wein in asbestos wo i k e i s a-du'si is henm a b di ited mari H' sium ill cate, im.d in :he mvk lae t m i "I ,i .In p a s y ah and n i 9eMM II ,. HID i$ \i I i p (>. \ x l h i h ' s l s \ H U (11 I- Cl I I >' t N U ,1 I 9 ( Im t ' t i c li i ' i s i r u 11 , i - i m : cl v s I P s cl M ' o 1'xhg-x'c 1 \ ' Of Is 0 lx h x` i 11 1 I y` )' ' n (xcj I ' h n i iiic - m i h Mi' o f I If 1l 't I h k \ ,1 H O M i 'o 'I t ! (' l l l l i l l l i l k IV " , p l o t it ,i I i n ' o i k L' Mk' i i l J i nI'i I'N WI M `I A Il'kNp! k ,id If - u : d f iLi tei al e n m g , plclll Il ls. The aie di sila ggy a'in aie lounii Vally in n d an,1 p e n ne less lo o in due to u ke 111e o m six /nunaiy ' h diary ,on of ol \as- mld he iiiaioul a Klell ! ,,/ nul . niisoH- iuIy, a nd due , \s Inch me to a ,e Cape Railiolog', ul Sm il1!(,li i r Olisi Discuses li^. 14. UliOjMlliie pulimui.ti \ h.u. inoiuk iom-> I K .iro.1 (>N _\uu s ! \ pk 11 huIlii s \mnI<i .ui in"Uil.itiun lieOUIlmlders, \ i Iders, i silver i eticuntl the <V 13) lopathic ai dust ares aie ks pread .dcd ap- I Kig. 13. Sideiosilicosis I H , aged !> seis I lesine welder (in loundnes) loi 30 seals Well deielopcd 5 sidemsis with nodulation P,meni espO'id lu sonie I Slliew dll'-l UUeeel h) Otllel SSl' Ikillio n Hg. 15. leliopalhic pulmonal} haeinosidei o is M O , ageel 20 veis Aeule liasniol) Ile phase Radiology di'M im e Rarer Dust Diseases KI 11 R 1 N ( l s a r r n , o N i, \. (19.13) I a pneuniiKoniosi il.i haliti Mt'tl. il. I.a\oro, 24, 461 Cam il a, R. (1951) Conti ibulo alla conoscenza dell'a/ione delle poh et i di halite suH'uomo Med il. I at'oio, 42, 221 C O C II K A N I , A. I Il A V I I S, I I I I 1 C II 1 K, C. M. (1951). l'utente f.itlioloyitj ne ; step touaids international agteemeiu on elassiliealnm of i.idio- gtaphs in pnenmoeoniosis. lint. J milusii Med 8, 244 ' C O L L , L. g . (1946) Pneumoconiosis In ( li m i a l io d i o - logy, edited by Ci U Pillinole Voi I Philadelphia Davis d a v il s , c. N.ed (1961) Inhaledpai tu lesami saponi s Proceedings of an International Symposium oi - ganised by the British Occupational H'ic'iene Society. Oxford : Petyamon Press ' D0 1 G, A T. (1950) Iron m the lungs Arch belva Med. soc., 8, 442 p o i g , A. T. (1956). Dust diseases, excluding hbioik pneumoconiosis. In Indiistttal nici/ume and hvnten , Voi. Ill, edited by P. k. A Meiewethei p' 121 London: Butteivsoith & Co I t CM, !.. (1938). Pneumoconiosis. In Occii/ninon and health. Geneva: International Luboui Ollicc F I O R I , (1938). Pneumoconiosis In Occupation and health. Geneva: International 1 abour Ollicc H I C K S, D. I A V, J W . J. A S it 1 O K | ) , j . u K v s (1961). 7he relation between pneimioeoniosis and ca vil annientai conditions London. 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Benign pncumonoconiosis ./. ittici. mctl iss 127 701 ' |J n I i i, l l a i i i n i, c < ( 1 9 1 9 ) Repot t of ih Inlet national (onvtcss on Int/usliial leudents and Oct npultonal Diseases tcip/ig. I lucilie " M l ' t l l S , Gltcd 1)> Si l l l>M s Nl, s J (1955) Diseases of the lungs In O sfotd ntcdh me, Voi 2, p. 116 Oxfoid (Iniseisit) Pass ' s l' l i) i n I, i v t u n i, i, a. i (1939) Contributo alla studio della pncumocomosi da baule Radiol ined ( I'm mu), 26, I v* 487 i