Case 20--Pneumoconiosis in a Woman

This case was contributed by Dr. Jamie Bigelow.

Clinical summary: A 74-year-old Mexican woman with no significant past respiratory history except for "asthma" presented to the chest clinic for preoperative clearance for a cholecystectomy. She had a 7-year history of episodic cough productive of white to yellow phlegm, which cleared with antibiotics, but was recurring at more frequent intervals. The cough had been constant for several months at the time of presentation. She also complained of progressive dyspnea on exertion over the same period such that she could now walk only about 4 blocks. She does not smoke cigarettes. She was originally from southern Mexico. Physical examination was remarkable for an increased second pulmonic sound and jugular venous distension. Lungs had rare rales and rhonchi. No clubbing was noted.

Pulmonary function tests:

4/92--Predicted (pred.)

Observed (% of pred.)

3/98--Pred.

Observed (% of pred.)

7/98--Pred.

Observed (% of pred.)

FVC

2.19

1.79 (82%)

2.1

1.59 (76 %)

2.1

1.48 (70%)

FEV1

1.53

1.02 (67%)

1.66

0.82 (49%)

1.66

0.82 (49%)

FEV1/FVC

80%

57%

80%

52%

80%

55%

TLC

3.56

3.76 (105%)

3.56

3.41 (96%)

DLCO

16.24

21.1 (130%)

15.5

12.5 (81%)

Interpretation: Moderate obstruction with no change after bronchodilators. Decreased diffusion since 1992.

Arterial blood gases (1992) were pH 7.4, pCO2 50 mmHg, and pO2 61 mmHg.

A chest radiograph showed abnormalities, and a CT was obtained.

A thoracoscopic lung biopsy was performed.

Histologic changes:Image 1 | Image 2 | Image 3 | Image 4 | Discussion

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