Chronic restrictive lung

diseases
Diffuse
Reduced expansion
Decreased total lung capacity

1)Chest wall disorder

Severe obesity, Kyphoscoliosis
Poliomyelitis
2)Interstitial and infiltrative diseases
Pneumoconiosis
Immunologic lung diseases
Collagen vascular diseases
Idiopathic pulmonary fibrosis
Sarcoidosis

Pathogenesis

Injurious stimuli
Inflammatory reaction
Alveolitis with L M N E
Inflammatory destruction of
parenchyma
Fibrosis
End stage Lung(honey comb lung)

Clical manifestations

Dyspnoea
Tachypnoea
Cyanosis
No wheezing

Pneumoconiosis
Group of lung diseases resulting
from inhalation of
inorganic and organic dust
Chemical fumes and vapour

Development of the
disease depends on

Amount of dust retained in air

spaces
Particle solubility and cytotoxicity
Size and shape of the particle
Other irritants

Most dangerous particle

size
Three types of reactions
1-5um
1)Fibrous nodules
2)Interstitial fibrosis
3)Hypersensitivity reactions

Coal workers
pneumoconiosis

Anthracosis

Simple coal workers pneumoconiosis

Complicated coal workers

pneumoconiosis(progressive massive
fibrosis)

Anthracosis

Benign
Asymptomatic
Not a lung disease
Seen in all urban dwellers
No cellular reaction
Carbon pigments engulf by
macrophages and accumulate
along lymphatics

Simple CWP

Macules 1-2mm and nodules

Carbon laden macrophages and
small amount of collagen
Upper lobes
Focal dust emphysema
Little derrangement of lung
function

Complicated CWP
In the back ground of Simple CWP after many
years(2-8%)
Black hard areas 2-10 cm
Bilateral
Upper parts
Dense collagen and carbon pigments
Necrosis
Progressive
Immunologic basis
Incidence of TB increased by 40%

Silicosis

Inhalation of crystaline silicon dioxide

Acute

Chronic

Significant lung disease after 10-15 years

Silicamacrophagesdeath release
particleactivate macrophagesGF
Fibroblast proliferation and collagen synthesis

Pathological changes

Hard fibrotic nodules 1-5 mm

Upper zones
Egg shell calcifications on chest x
ray
Ischaemic necrosis cavities
Thickened pleura
Increased susceptibility to TB

Asbestose disease

Three types of asbestose fibers

Crysolit (white)-soft proximal
Crosidolite (blue) Rigid reach
peripharal parts carcinogenic
Amosite (brown)
Disease depends on the amount of
dust inhaled

Pathogenesis

Exposure
macrophages
fibrogenic enzymes and GF
Fibrosis

Pathological changes
3 types of lesions
1) Asbestosis
2)Pleural disease
3)Tumours

Asbestosis

Gross pulmonary fibrosis

Asbestose bodies
Lungs are small and firm
Cartilage like thickening of pleura
Begins at lower lobes sub pleurally
Smoking has an additive effect

Pleural disease

3 types of pleural lesions

1)Effusions
2)Visceral pleural fibrosis
3)Fibrotic plaques

Effusion

5% of cases

Fibrotic pleural plaques

Appear as circumscribed flat small (up to
1cm) hard bilateral nodules.
They are consist of hyalinized collagenous
tissue which may be calcified
They DO NOT CONTAIN ASBESTOSE
BODIES.

TUMOURS

Bronchogenic carcinoma most common

Smoking greatly increases the risk but
not that of mesothelioma
Malignant mesothelioma
CA oesophagus
CA stomach,colon,larynx,kidney and
various haematological malignancies.

Rheumatoid pneumoconiosis
Coexistance of rheumatoid arthritis with a
pneumoconiosis.
Occurs in CWP, silicosis, and asbestosis
Grossly firm nodules with central necrosis
cavitations or calcifications
Micro-Modified rheumatoid nodules
Rheumatoid factor ,antinuclear factor