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Author: Admin | 2025-04-28
Large cavities within the lung.Simple BLD is marked by the presence of 1–2 mm (0.039–0.079 in) nodular aggregations of anthracotic macrophages, supported by a fine collagen network, within the lungs. Those 1–2 mm in diameter are known as coal macules, with larger aggregations known as coal nodules. These structures occur most frequently around the initial site of coal dust accumulation—the upper regions of the lungs around respiratory bronchioles.[4] The coal macule is the basic pathological feature of BLD and has a surrounding area of enlargement of the airspace, known as focal emphysema.[14][15] Focal emphysema extends into progressive centrilobular emphysema. Less commonly a variant of panacinar emphysema develops.[16]Continued exposure to coal dust following the development of simple BLD may progress to complicated BLD with progressive massive fibrosis (PMF), wherein large masses of dense fibrosis develop, usually in the upper lung zones, measuring greater than 1 cm (0.39 in) in diameter, with accompanying decreased lung function. These cases generally require a number of years to develop. Grossly, the lung itself appears blackened. Pathologically, these consist of fibrosis with haphazardly-arranged collagen and many pigment-laden macrophages and abundant free pigment. Radiographically, BLD can appear strikingly similar to silicosis. In simple BLD, small rounded nodules predominate, tending to first appear in the upper lung zones. The nodules may coalesce and form large opacities (>1 cm), characterizing complicated BLD, or PMF.Micrograph of anthracosis, with interstitial pigment deposition (black arrow) and an anthracotic macrophage (white arrow)There are three basic criteria for the diagnosis of BLD:Chest radiography consistent with BLDAn exposure history to coal dust (typically underground coal mining) of sufficient amount and latencyExclusion of alternative diagnoses (mimics of BLD)Symptoms and pulmonary function testing relate to the degree of respiratory impairment but are not part of the diagnostic criteria. As noted above, the chest X-ray appearance for BLD can be virtually indistinguishable from silicosis. Chest CT, particularly high-resolution scanning (HRCT), are more sensitive than plain X-ray for detecting the small round opacities.There is no cure or discovered treatments for pneumoconiosis. The treatments that are available only relieve the symptoms but do not reverse or stop the illness. Some patients are given supplemental oxygen to help with their breathing and are advised to stop smoking to prevent further decline in lung function. In the most extreme cases, a lung transplant could be done to help prolong the patient's life expectancy.[17]Prevention of pneumoconiosis[edit]The main way to avoid contracting coal worker's pneumoconiosis is to avoid the inhalation of coal dust. Some of the ways to prevent this disease include: wearing ventilated masks, such as NIOSH-certified respirators, when coming in contact with potentially dangerous airborne particles; regular pulmonary exams; and becoming educated about the risks of lung diseases in your work environment.[18]
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