Coal workers' pneumoconiosis

Topic Completed: 1 September 2011

Minor changes: 5 January 2021

Copyright: 2003-2021,, Inc.

PubMed search: coal workers pneumoconiosis [title] OR progressive massive fibrosis [title]

Elliot Weisenberg, M.D.
Page views in 2020: 2,313
Page views in 2021 to date: 2,269
Cite this page: Weisenberg E. Coal workers' pneumoconiosis. website. Accessed October 25th, 2021.
Definition / general
  • Incidence declining due to dust reduction measures

Simple coal workers' pneumoconiosis (CWP):
  • Patients have coal macules (1 - 2 mm collections of carbon laden macrophages) and coal nodules (coal macules and fibrosis) scattered throughout lung, more in upper lobe and upper lower lobe, near respiratory bronchioles
  • Usually minimal symptoms but 10% develop progressive massive fibrosis

Progressive massive fibrosis:
  • Also called complicated coal workers' pneumoconiosis
  • Intensely blackened scars > 2 cm, multiple and containing dense collagen and pigment
  • Center of lesion may be necrotic due to ischemia
  • Associated with pulmonary hypertension and cor pulmonale
  • May progress even if dust exposure ceases
  • Due to any pneumoconiosis, although most common in CWP and silicosis
  • Associated with increased incidence of clinical tuberculosis, chronic bronchitis and emphysema and independent of smoking
  • In isolation, not appear to increase the risk of lung cancer

Caplan syndrome:
  • Rheumatoid arthritis and pneumoconiosis cause rapidly developing nodular pulmonary lesions showing central necrosis surrounded by collagen, fibroblasts and macrophages (similar to rheumatoid nodules)
  • Associated with exposure to coal, asbestosis and silica dust
Microscopic (histologic) images

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Coal workers' pneumoconiosis

Coal workers' pneumoconiosis

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