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Mohammad Tohidi M.D. Professor of Internal Medicine Department of Pulmonary Medicine Ghaem Hospital MUMS Mashhad IRAN. Silicosis. Case Scenario(1).
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Professor of Internal Medicine
Department of Pulmonary Medicine
Ghaem Hospital MUMS Mashhad IRAN
chest exam were normal.Chest X ray showed diffuse reticulonodular pattern There were no hilar enlargement & calcification.
no ground glass pattern,hilar adenopathy
& pleural effusion.He had >30 years Hx of stone cutting & grinding.With this Hx & immaging studies, in the absence of another causes,diagnosis of simple silicosis was apparent.
Crystalline forms of silica (Silicon Dioxide or SiO2) include quartz, cristobalite, and tridymite. Quartz is the most common type, and is a major component of rocks including granite, slate, and sandstone.
Full description by Bernardino Ramazzini (1633-1714) in early 18th century. “...when the bodies of such workers are dissected, they have been found to be stuffed with small stones.”Diseases of Workers (De Morbis Artificum Diatriba, 1713).
Progressive massive fibrosis
Lung CancerMycobacterial InfectionMycobacterium tuberculosis Nontuberculous Mycobacteria Immune-Related DiseasesProgressive systemic sclerosis Rheumatoid arthritis Chronic renal disease Systemic lupus erythematosus
• Particle size is critical.
• Peak dust inhalation
occurs with particles
having a diameter of 0.5 to
3 microns (μm).
• RCS is invisible to the
• Pulmonary clearance
macrophages & the
4 The intensity of the exposure determines the nature of the lung injury. Low-intensity exposure generally produces aggregates of fibrosis with relative sparing of the lung architecture, whereas high-intensity exposure causes widespread pulmonary inflammation and collagen deposition
5 Individual susceptibility to the disease may play a role
transported upward and removed from lungs retained in the lung “Frustrated Phagocytosis”
cascade of toxic effects
fibrosis in the lung tissue
(1) Chronic silicosis
Occurs after 15-20 years of exposure to moderate to low levels of silica dust. Chronic silicosis itself is further subdivided into:
Early cases of the disease do not present any symptoms
Silicosis that develops 5-10 years after high exposure to silica dust. Symptoms include severe shortness of breath, weakness, and weight loss
Silicosis that develops a few months to 2 years after exposure to very high concentrations of silica dust.
Can usually make right diagnosis with detailed history (occupational & medical) or, rarely, a lung biopsy.
simple silicosis progressive massive fibrosis
noal chest x-ray
described in SA gold miners