2. Coal Worker’s Pneumoconiosis ( CWP )
DR.S.H.HASHEMI

3. TERMINOLOGY
COAL is used as a basic fuel for numerous industries requiring a source of heat.
Coal dust containe Silica, Kaolin, PAH, Quarts, Carbon .
Pneumoconiosis : the radiologic or pathologic appearances relating to the accumulation of lung dust deposits and the associated tissue reactions.

4. Clinical effects of coal dust :
Acute effects: acute drop in FEV1 ( months to years ).
Chronic effects: CWP (≥ y )
Term CWP: a chronic, irriversible disease with insidious onset
A heavy coal dust burden is required to induce CWP
Rarely in those who have spent fewer than years under ground.

5. LUNG PATHOLOGY( Pigmented lesions )
Accumulation of dark pigment(coal dust) in alveolar MQ >> MQ activity >> inflamatory changes >> product Reticolin >> MACULE (primary lesion in CWP ).

6. LUNG PATHOLOGY( Black lung )

7. MACULE Destract of alveolar walls Emphysema Collagen Scar
Dust deposition Massive lesions
Cavitation Black liquid

8. Location of macule
Primary lesion in upper lobe , upper segment lower lobe .

9. Clinical manifestation
Simple CWP: lesions in CXR <10 mm diameter asymptomatic

10. Clinical manifestation . . .
Complicated CWP (PMF): lesions in CXR >10 mm diameter

11. Clinical manifestation . . .
Complicated CWP (PMF):
Chronic Bronchitis: chronic couph and productive sputum
Emphysema
Silicosis:(due to silica)CWP and Silicosis often see in coal miner
Silicosis is pathologically distinct from CWP
Two disorders often cannot distinguished radiographically
Mycobactrial infection: (TB ,other mycobactrial dx due to silica )
Caplan Sx (Rheumatoid pneumoconiosis ): CWP + RA(joint disorder , rheumatiod nodule )
Malignancy: Lung cancer, gastric cancer, bladder, skin, scrotum

12. Pathologic classification of coal mine dust-induced changes

13. Imaging
CXR:
Simple CWP: lesions <10 mm diameter(3-10 mm), round or irregular
Complicated CWP (PMF): lesions >10 mm diameter
CXR is insensitive to early pathologic intrestitial and emphysematous changes.which may be found pathologically or on HRCT with normal routin CXR.
May by visible abnormal in CXR whitout clinical disease (preclinical stage) if remove Pt from exposure decrease progression of dx .
if CWP whit silica exposure in CXR hilar LN calcification

14. CXR . . .

15. Complicated CWP (PMF)

16. Complicated CWP (PMF)

17. Emphysema
PMF

18. Cavitation
PMF
Emphysema

19. Caplan Sx (Rheumatoid pneumoconiosis )

20. Imaging . . .
CT scan: for pneumoconiotic nodules and PMF, when they were not apparent on routin CXR .
HRCT: high sensitive for emphysema in early stage .
Gallium scan: increased activity but not specific .
MRI: no utility

21. Imaging . . .

22. ABG: hypoxia, hyper capnia
PFT:
Simple CWP: no significant abnormality
Comlicated CWP (PMF):
restrictive or mixed pattern
DLCo
ABG: hypoxia, hyper capnia

23. Prognosis Simple CWP: benign course
Complicated CWP: mild to sever respiratory symptoms and impairment

24. Prevention 1° prevention: decrease exposure Dilution ventilation
Dust suppression
Increase fresh air
Water spray near the cutting head
Respirator

25. Prevention . . . 2° prevention: Examination CXR
Spirometery (decrease ≥ 15% FEV1 from baseline is significant )