Newly recognized occupational and environmental causes of chronic terminal airways and parenchymal lung disease

Abstract

With the introduction of new materials and changes in manufacturing practices, occupational health investigators continue to uncover associations between novel exposures and chronic forms of diffuse parenchymal lung disease and terminal airways disease. To discern exposure-disease relationships, clinicians must maintain a high index of suspicion for the potential toxicity of occupational and environmental exposures. This article details several newly recognized chronic parenchymal and terminal airways. Diseases related to exposure to indium, nylon flock, diacetyl used in the flavorings industry, nanoparticles, and the World Trade Center disaster are reviewed. Also reviewed are methods in worker surveillance and the potential use of biomarkers in the evaluation of exposure-disease relationships.

Figure 1

High resolution computed tomography scan of Indium Lung. The (A) left and (B) right chest showing bilateral ground glass opacities, centrilobular nodules, and intralobular and interlobular septal thickening. (from Cummings, K. Donat W. Ettensohn, David. Pulmonary Alveolar Proteinosis at an Indium Processing Facility. Am J Respir Crit Care Med. 181; 2010: 458–64, with permission)

Figure 2

Histopathological sections of lung biopsy, hematoxylin and eosin stain. (A) Low-power overview showing filling of alveolar spaces by eosinophilic material (magnification 310). (B) High-power view showing granular eosinophilic material and cholesterol clefts. (magnification 3200). Birefrigent particles were identified with polarizing microscopy, consistent with the presence of crystalline indium-tin oxide. (C) Periodic acid-Schiff (PAS) stain after diastase digestion, showing granular, PAS-positive intraalveolar material, and cholesterol clefts (magnification X100). from Cummings, K. Donat W. Ettensohn, David. Pulmonary Alveolar Proteinosis at an Indium Processing Facility. Am J Respir Crit Care Med. 181; 2010: 458–464, with permission).

Figure 3

Nylon Flock Worker’s Lung Histopathology: Photomicrographs of thoracoscopic lung biopsy specimen from nylon flock plant worker. Histology reveals lymphocyte predominant infiltrate surrounding bronchiole in center of lobule. Original magnification of photomicrograph: (A) 3100; (B) 3250. Eschenbacher W, Kreiss, K, Lougheed, D. et al. Nylon Flock-Associated Interstitial Lung Disease. Am J Respir Crit Care Med 1999; 159: 2003–2008.

Figure 4

Radiographic imaging in Nylon Flock Worker’s Lung: Eschenbacher W, Kreiss, K, Lougheed, D. et al. Nylon Flock-Associated Interstitial Lung Disease. Am J Respir Crit Care Med 1999; 159: 2003–2008.

Figure 5

Bronchiolitis Obliterans: High-resolution computed tomography chest scan: E Expiratory, showing patchy air trapping. (Courtesy of Ami Rubinowitz, MD Yale School of Medicine)

Figure 6

Constrictive bronchiolitis: Marked submucosal fibrosis causing severe narrowing of the airway lumen (Courtesy of Robert Homer, MD/PHD, Yale School of Medicine)