Pneumoconioses and Their Masqueraders

Our plain-English summary of Pneumoconioses and Their Masqueraders, by H.S. VanOrdstrand (1977).

The study

• Author: H.S. VanOrdstrand
• Published: Journal of Occupational Medicine, Volume 19 No11. November 1977
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This 1977 conference paper did not study a defined group. The author, from the Cleveland Clinic, gave a personal classification of occupational lung diseases and described single patients whose x-rays suggested a work-related lung disease but who had something else. In the asbestos example, a man who had spent 20 years in the insulation industry had an x-ray interpreted as most likely asbestosis. A lung biopsy instead showed fibrosing interstitial pneumonitis of the Hamman-Rich syndrome, with no microscopic signs of asbestosis. The other masquerader examples followed the same pattern. Apparent silicosis was cancer spread from the stomach. Apparent berylliosis was sarcoidosis. Apparent coal worker's pneumoconiosis was desquamative interstitial pneumonitis. Apparent talcosis was bronchiolar alveolar cell carcinoma. Apparent diatomaceous earth pneumoconiosis was lymphocytic lymphoma, and apparent farmer's lung was tropical eosinophilia. The article also showed an x-ray of a typical advanced case of Shaver's disease, to explain why its look-alikes must be considered. The author concluded that no job makes a worker immune to non-occupational diseases, and that the microscope is often the most important diagnostic tool.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative article giving the author's personal classification of the pneumoconioses and hypersensitivity occupational lung reactions, with tables and single illustrative patient cases; presented at a meeting
• Who was studied: Individual patients described as examples, apparently from the author's practice at the Cleveland Clinic: a 30-year glass worker, a 20-year insulation worker, a 20-year beryllium worker, a bituminous coal miner of 20 years, a woman with over 20 years in the rubber tire industry, a diatomaceous earth worker, and a farmer. No overall number of patients is given.
• Exposure: Various occupational dusts: asbestos in the insulation industry (fiber type not named), free crystalline silica in glass work, beryllium compounds, coal, soapstone in rubber tire work, calcined diatomaceous earth (cristobalite, spelled 'crystobalite' in the article), heat-treated bauxite (Shaver's disease), and hay (farmer's lung)
• Main results:
  • Insulation worker (20 years, asbestos exposure): the x-ray was interpreted as most likely asbestosis. A lung biopsy showed fibrosing interstitial pneumonitis of the Hamman-Rich syndrome with no histologic signs of asbestosis. His symptoms had lasted less than one year.
  • Glass worker (30 years): the x-ray was interpreted as silicosis. A surgical lung biopsy showed the nodules were metastases from a signet ring cell carcinoma, most compatible with a stomach primary.
  • Beryllium industry worker (20 years): the diagnosis was established as sarcoidosis, which the author called the most difficult differential diagnosis for berylliosis.
  • Bituminous coal miner: the x-ray suggested simple coal worker's pneumoconiosis (CWP). Histology showed desquamative interstitial pneumonitis.
  • Shaver's disease: the article showed an x-ray of a typical advanced case, not a masquerader, to explain why the listed masqueraders need to be considered.
  • Woman exposed to soapstone in the rubber tire industry: the x-ray was interpreted as talcosis. Histology showed bronchiolar alveolar cell carcinoma.
  • Diatomaceous earth worker: pneumoconiosis was suspected. A needle biopsy showed lymphocytic lymphoma.
  • Farmer (discussed under immunologic occupational lung disorders): the x-ray was interpreted as probable farmer's lung. Biopsy showed tropical eosinophilia, and he recovered after arsenical therapy.
• The authors' conclusion: The author concluded that no occupation makes a worker immune to non-occupational diseases that can mimic dust diseases on x-ray, and that the microscope (biopsy) is often the most important diagnostic tool.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Lung Disease, Biopsy, Interstitial, Pneumonitis, Silicosis, Pneumoconiosis, Carcinoma, Occupational Disease.

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