Talc Dust Pneumonia
Introduction
Introduction to talc dust lung Talc dust lung is a pulmonary interstitial fibrotic disease caused by long-term inhalation of talc dust during the production process. basic knowledge Proportion of disease: The incidence of talc industrial workers is about 0.01%-0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: pulmonary hypertension, respiratory failure, lung cancer
Cause
Talc pneumoconiosis
(1) Causes of the disease
Talc is a kind of hydrous magnesium silicate. The pure talc is in the form of flakes or granules. Industrial talc often contains various silicates, quartz, magnesia, sulfides and silicates often associated with talc. Even containing a certain amount of asbestos, talc is widely used in rubber, textile, ceramics, paper, medicine, cosmetics, paints, pesticides, advanced insulation materials, etc., using talcum powder as a filler, anti-adhesive agent and poor conductor.
(two) pathogenesis
Long-term inhalation of talc mainly causes nodular fibrosis, diffuse interstitial fibrosis and foreign body granuloma. Interstitial fibrosis is similar to asbestosis and is distributed around the respiratory bronchioles. There is a small amount of collagen fiber in addition to reticular fibers. Irregularly arranged, the granuloma consists of epithelial-like cells and foreign body giant cells. In the giant cells, there are birefringent talc particles, pleural thickening and even pleural plaque on the pleura, often called "slip plaque". It may also be associated with asbestos fibers mixed with talc, and the hilar lymph nodes may be moderately enlarged.
Prevention
Talc dust prevention
Patients have a close history of dust exposure and detailed occupational history, resulting in a lot of dust lung work, long-term exposure to a variety of metal, coal powder, refractory materials, stone powder, cement, glass, ceramics and other workers.
1. The key to controlling or reducing the incidence of dusty lungs is dust prevention. Industrial and mining enterprises should grasp comprehensive dust prevention measures such as reforming production technology, wet operation, closed dust source, ventilation and dust removal, equipment maintenance and repair.
2. Strengthen personal protection and comply with dustproof operating procedures. Regularly monitor the dust concentration in the air in the production environment and strengthen publicity and education. Do a good physical examination before employment, including X-ray.
3. Anyone with active pulmonary tuberculosis and various respiratory diseases should not participate in the work of dust. Regular physical examinations of workers, including X-ray films, are performed, and the interval between examinations depends on the amount of silica contacted and the concentration of airborne dust.
4. Strengthen the prevention and control of tuberculosis in industrial and mining areas. Those who are negative for tuberculin test should be vaccinated with BCG; positive for preventive anti-tuberculosis chemotherapy to reduce the incidence of pneumoconiosis combined with tuberculosis.
5. Comprehensive measures should be taken for patients with dusty lungs, including dust-free operation, and appropriate work according to the arrangement, strengthening nutrition and proper rehabilitation exercises to enhance physical fitness. Prevent the occurrence of respiratory infections and combined symptoms.
Complication
Talc dust lung complications Complications pulmonary hypertension pulmonary failure lung cancer
The most common comorbidities are pulmonary hypertension, respiratory failure, lung cancer and pleural tumors.
Symptom
Talc dust lung symptoms Common symptoms Breathing difficulty Shortness of breath, snoring, snoring, dry cough, heart failure
The onset is mostly hidden, with shortness of breath, cough, and cough as the main symptoms. It is often asymptomatic for many years of contact, but it is urgent in the late stage of exertion, with cough, cough, and difficulty in breathing. Progressive patients may have difficulty in activities. Especially in diffuse interstitial fibrosis and X-ray chest radiographs with blocky shadows, the symptoms often appear after 15 to 20 years of contact with talc, only granuloma, the main symptoms are progressive shortness of breath and dry cough, often mild .
Early symptoms are mild and signs are less. Blocky shadows may affect local thoracic dilatation. There may be wheezing and dry voices. In severe cases, there may be signs of heart failure, clubbing (toe) and cyanosis.
Examine
Talc dust lung examination
There are birefringent talc particles visible in giant cells.
1. Pulmonary function test Pulmonary function test in the early nodular lesions without abnormalities, late restrictive ventilatory disorders, decreased lung compliance, mainly showing vital capacity, maximum ventilation and total lung volume decreased, while DLco decreased slightly, continue Development of FEV1 (forced expiratory volume in one second), FVC (forced vital capacity), etc. are further reduced with pulmonary fibrosis and small pulmonary nodules, blood and blood exchange is impaired and blood oxygen saturation decreases after activity, in diffuse When interstitial fibrosis is predominant, lung function changes with asbestosis lung, and lung compliance decreases when foreign body granuloma is predominant.
Pulmonary function lung function was measured in the early nodular lesions without abnormalities, late restrictive ventilatory disorders, decreased lung compliance, mainly showing decreased lung capacity.
The maximum ventilation pulmonary function was measured in the early nodular lesions without abnormalities, and later limited ventilatory dysfunction, decreased lung compliance, mainly showed a decrease in maximum ventilation.
Pulmonary function in lungs was measured in the early nodular lesions without abnormalities. Restrictive ventilatory disorders occurred in the later stage, and lung compliance decreased, mainly showing a decrease in total lung volume.
One second of forced expiratory lung function was measured in early nodular lesions without abnormalities, late restrictive ventilatory disorders, decreased lung compliance, continued development of FEV1 (forced expiratory volume in one second) with pulmonary fibrosis and intrapulmonary Small nodules increase and further decrease.
Forced vital capacity lung function was measured in the early nodular lesions without abnormalities, late restrictive ventilatory disorders, decreased lung compliance, and continued development of FVC (forced vital capacity) decreased with pulmonary fibrosis and increased intrapulmonary nodules.
2. X-ray performance increased with the increase of talc dust exposure time, X-ray showed nodular type: 3 ~ 5mm small nodule shadow, late can be merged into a mass; mesh shadow: early netting is fine, Mainly in the middle and outer belts, the appearance of ground glass, increased in the late stage, the disorder can be changed in the honeycomb lung, mixed: nodules are mixed in the net, the pleura is thickened, the rib angle becomes dull, and there may be pleural plaques. Pleural calcification can occur on the transverse diaphragm surface.
Diagnosis
Diagnostic identification of talc dust lung
diagnosis
Mainly based on past talc contact history and X-ray.
Differential diagnosis
It needs to be differentiated from quiescent tuberculosis and granulomatosis.
