SUNY Upstate Medical University, Syracuse, NY
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Student/Resident Case Report Poster - Occupational and Environmental Lung Diseases
SESSION TYPE: Student/Resident Case Report Poster
PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM
INTRODUCTION: Asbestos exposure can lead to several pulmonary and pleural pathologies, including asbestosis and mesothelioma. We present a case of asbestosis which was acquired solely from working at talc mine located in Upstate New York.
CASE PRESENTATION: A 63-year old male with 40 pack year smoking history arrived at the emergency department after sustaining a mechanical fall at home. He was initially admitted for renal laceration to Urology Service. His past medical history was significant for hypertension, hyperlipidemia and diabetes mellitus. He previously worked as a stone crusher at a talc mine in Upstate New York for 20 years and had no other occupation known to cause asbestos exposure. He was noted to be hypoxic and was transferred to the Medicine Service for further work-up. CT thorax was done which revealed upper lobe predominant emphysematous changes, bilateral pleural plaques and with fibrotic changes. Pulmonary function testing showed a restrictive ventilatory defect with a severe diffusion deficit. Transbronchial biopsies showed severe respiratory bronchiolitis, focal mild fibrosis and asbestos bodies. A diagnosis of asbestosis was made given clinical and radiological findings and recovery of asbestos bodies from pathology.
DISCUSSION: Presence or absence of amphibole asbestos in New York talc mine has been a subject of debate for many decades1. It has been recognized that the workers exposed to talc are at risk for pneumoconiosis1. Multiple studies have shown development of pleural plaques and mesothelioma after exposure of talc2,3. In our case, detection of asbestos fibers in the lung biopsy suggests a direct correlation between working at talc mines and development of talc asbestosis2, 3.
CONCLUSIONS: Asbestos exposure has been associated with significant morbidity and mortality. As demonstrated in this case, talc mine workers represent an additional population at risk for developing asbestosis and potentially mesothelioma. As multiple talc mines were still operating in Upstate New York until 2011, health care providers awareness is required to potentially identify patients with talc asbestosis and conduct further studies to better understand perils associated with talc mines.
Reference #1: Finkelstein M. Pneumoconiosis and malignant mesothelioma in a family operated metal casting business that used industrial talc from New York state. American Journal Of Industrial Medicine [serial online]. May 2013;56(5):550-555.
Reference #2: Finkelstein M. Malignant mesothelioma incidence among talc miners and millers in New York State. American Journal Of Industrial Medicine [serial online]. October 2012;55(10):863-868.
Reference #3: Hull, M. J., Abraham, J. L., & Case, B. W. (2002). Mesothelioma among workers in asbestiform fiber-bearing talc mines in New York State. Annals of Occupational Hygiene, 46(suppl 1), 132-135.
DISCLOSURE: The following authors have nothing to disclose: Prathik Krishnan, Milan Patel, Poornima Ramadas, Dragos Manta
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