Abstract
Pneumoconioses represent the spectrum of lung diseases caused by inhalation of respirable
particulate matter small enough (typically <5-µm diameter) to reach the terminal airways
and alveoli. Pneumoconioses primarily occur in occupational settings where workers
perform demanding and skilled manual labor including mining, construction, stone fabrication,
farming, plumbing, electronics manufacturing, shipyards, and more. Most pneumoconioses
develop after decades of exposure, though shorter latencies can occur from more intense
particulate matter exposures. In this review, we summarize the industrial exposures,
pathologic findings, and mineralogic features of various well-characterized pneumoconioses
including silicosis, silicatosis, mixed-dust pneumoconiosis, coal workers' pneumoconiosis,
asbestosis, chronic beryllium disease, aluminosis, hard metal pneumoconiosis, and
some less severe pneumoconioses. We also review a general framework for the diagnostic
work-up of pneumoconioses for pulmonologists including obtaining a detailed occupational
and environmental exposure history. Many pneumoconioses are irreversible and develop
due to excessive cumulative respirable dust inhalation. Accurate diagnosis permits
interventions to minimize ongoing fibrogenic dust exposure. A consistent occupational
exposure history coupled with typical chest imaging findings is usually sufficient
to make a clinical diagnosis without the need for tissue sampling. Lung biopsy may
be required when exposure history, imaging, and testing are inconsistent, there are
unusual or new exposures, or there is a need to obtain tissue for another indication
such as suspected malignancy. Close collaboration and information-sharing with the
pathologist prior to biopsy is of great importance for diagnosis, as many occupational
lung diseases are missed due to insufficient communication. The pathologist has a
broad range of analytic techniques including bright-field microscopy, polarized light
microscopy, and special histologic stains that may confirm the diagnosis. Advanced
techniques for particle characterization such as scanning electron microscopy/energy
dispersive spectroscopy may be available in some centers.
Keywords
occupational exposure - silicosis - coal workers' pneumoconiosis - asbestosis - berylliosis
- hard metal pneumoconiosis
