Pulmonary Talcosis

Pulmonary Talcosis Clinical Features:

• May initially have non-specific respiratory symptoms.
• Examination may show finger clubbing & respiratory crackles.
• Condition may progress even after exposure has halted.
• More severe symptoms with disease progression include dyspnoea, hypoxaemia & eventually pulmonary hypertension with cor pulmonale.

Talcosis Radiological Features:

• May be pleural plaques similar to asbestos plaques.
• The plaques will often involve the diaphragm, & also occasionally the pericardium.
• Interstitial disease pattern - reticular or nodular, which may appear like asbestosis.
• May develop confluent masses.

Talcosis Aetiological Factors:

• Exposure may be either inhalational or intravenous.
• Industrial settings - mining, milling, rubber industry.
• High exposure from personal talcum powder use.
• Heroin use - where talc is used as an adulterant.

Talcosis Pathophysiology:

• Talc is hydrated magnesium silicate.
• Related to silicosis in view of silicate composition.
• Talc may cause disease in association with other minerals, as there is often contamination with silica, or asbestos.

Image Details: Granulomatous inflammation of the lung secondary to a foreign body reaction in heroin intravenous drug use (IVDU), foreign material demonstrated as talc, H&E stain. By Nephron on Wikipedia (cc)

Tags: Asbestos - Heroin - IVDU - Magnesium Silicate - Milling - Mining - Silica - Silicosis - Talcosis - Inhalational Talcosis - Talcosis
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Reactive Airways Dysfunction Syndrome (RADS)

Reactive Airways Dysfunction Syndrome (RADS):

• Persistence of hyper-reactive airways following acute exposure to a respiratory irritant.
• Typically follows a work-related spill or accident.
• The exposure is usually single & intense.
• Can be thought of as an irritant induced asthma.

RADS Clinical Features:

• Symptoms of airways disease - dyspnoea, wheeze, cough.
• Occurring in patient with no previous history of respiratory disease.
• Symptoms beginning within 24 hours of exposure .
• No latent period of prior 'sensitization'.
• Re-exposure to a low dose of the irritant will typically not trigger asthma.
• In work-related cases, the patient may continue to work in the same building once measures have put in place to avoid exposure.
• Bronchial hyper-reactivity can demonstrated, ie methacholine challenge test.
• Pulmonary function tests may be normal or obstructive.
• The features noted may persist for months to years.

Irritant Agents (Examples):

• Acids
• Ammonia
• Chlorine
• Cleaning agents
• Smoke

Tags: Acids - Ammonia - Asthma - Chlorine - Cleaning Agents - Methacholine Challenge Test - RADS - Reactive Airways Dysfunction Syndrome - Smoke
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Drug-Induced Pulmonary Eosinophilia

Drug-Induced Pulmonary Eosinophilia:

• Drug associated transient pulmonary infiltrates, with an elevated eosinophil count.
• Clinical spectrum is variable.

Clinical Spectrum:

• Acute picture - simulating hypersensitivity pneumonitis - ie cocaine.
• Insidious onset picture - chronic symptoms & dyspnoea - ie nitrofurantoin.
• Loeffler-like picture - ie penicillin.
• Eosinophilic vasculitis picture - ie zafirlukast.

Drug Causes (Antibiotics):

• Ampicillin
• Minocycline
• Nitrofurantoin
• Penicillin
• Pentamidine (aerosolized)
• Sulfonamide

Drugs Causes (Other):

• Chlorpropamide
• Crack Cocaine
• L-tryptophan
• NSAIDs
• Paracetamol (Acetaminophen)
• Ranitidine
• Zafirlukast

Tags: Antibiotics - Cocaine - Drug-Induced Pulmonary Eosinophilia - Eosinophilic vasculitis - Nitrofurantoin - Pneumonitis - Pulmonary Eosinophilia - Pulmonary Infiltrate
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Hyperventilation (Definition)

Hyperventilation (Definition):

• Alveolar ventilation which is inappropriately high in relation to metabolic rate.
• The ventilation is sufficient to produce arterial hypocapnia - i.e. PaCO2 less than 4.7 kPa.

Tags: Alveolar Ventilation - Hyperventilation - Hypocapnia - Metabolic Rate
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Spontaneous Pneumothorax Causes

Aetiology:

• Idiopathic - majority of causes
• Air Space Disorder - Bullae, Cysts, Emphysema
• Airways Obstruction - Asthma, Chronic airflow obstruction
• Connective Tissue Disorder - Ehler's-Danlos syndromes, Marfan's syndrome
• Generalised Lung Disease - Eosinophilic granuloma, Pneumoconiosis, Pulmonary fibrosis
• Localised Lung Disease - Hydatid disease, Lung abscess, TB, Tumour
• Mediastinal Emphysema - Decompression of divers

Prognosis:

• Recurs in 20% when no underlying lung disease identified.
• Recurrence rate of more than 50% in patients with chronic lung disease.

Image: Left Tension Pneumothorax

Image Credit: by Clinical Cases on Wikipedia (cc)

Tags: Asthma - Bullae - Ehler's-Danlos syndrome - Hydatid Disease - Marfan's syndrome - Pneumoconiosis - Pneumothorax - Pulmonary Fibrosis - TB - Tumour
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Recurrent Pulmonary Infiltrates - Same Area Of Lung

Aetiology:

Bronchiectasis - Congenital or acquired

Bronchogenic cyst - recurrent infections

Broncho-oesophageal fistula - ie neoplastic

Bronchopulmonary sequestration - recurrent infections

Local bronchial narrowing:

* Intraluminal - broncholith, foreign body

* Endobronchial - neoplasm

* Peribronchial - lymph nodes, mediastinal mass

Tags: Bronchiectasis - Bronchogenic Cyst - Broncho-oesophageal Fistula - Bronchopulmonary Sequestration - Infection - Mediastrinal Mass - Neoplasm - Pulmonary Infiltrate
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Lymphocytic Interstitial Pneumonitis (LIP)

LIP General Facts:

• Lymphocytic Interstitial Pneumonitis (LIP) is a lymphoproliferative lung disorder.
• Pathologically there is diffuse infiltration of lymphocytes, plasma cells & immunoblasts along lymphatics & in alveolar septae.
• Diagnosis - open lung biopsy, with above histological features & infection excluded.

LIP Clinical Features:

• Uncommon.
• No obvious cause apparent.
• Presents with cough, dyspnoea & fever.
• Tends to occur earlier rather than later in the course of HIV infection.

LIP Radiological Examination:

Chest Xray:

• May be normal.
• Typically reveals reticular or nodular infiltrates.
• Infiltrates predominantly basilar in location.

CT Chest:

• Peribronchovascular nodules (2-4 mm in diameter).
• Ground glass opacities may be present.

LIP Prognosis:

• Varies from benign course (with spontaneous resolution or stabilisation) to respiratory failure.

Tags: HIV infection - LIP - Lymphocytic Interstitial Pneumonitis - Open Lung Biopsy

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