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Diffuse lung disease caused by cotton dust exposure
Article · August 2018
DOI: 10.15406/cmiij.2018.01.00016
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Clinical and Medical Images International Journal
Clinical Images Open Access
Diffuse lung disease caused by cotton dust exposure
Abstract Volume 1 Issue 3 - 2018
Byssinosis is an occupational lung disease caused by the inhalation of cotton, flax and
Balakrishnan Menon,1 Parul Mrigpuri,2 Mani
hemp fibers. Workers from all levels of cotton processing carding, blowing, spinning and
weaving- are exposed to cotton dust. We present a case of Byssinosis in a 28year-old man
Tiwari,3 Praveen Raj4
Department of Pulmonary Medicine, University of Delhi, India
working at a cotton factory for 6years. He presented to the emergency department with
cough, breathlessness and fever. Correspondence: Balakrishnan Menon, Department of
Pulmonary Medicine,Vallabhbhai Patel Chest Institute, University
Keywords: inhalation of cotton, byssinosis, pulmonary fibrosis, pneumoconiosis,
of Delhi, India, Email [email protected]
clinical examination
Received: June 14, 2018 | Published: August 27 2018
Background predicted). Patient underwent Bronchoscopy and transbronchial lung
biopsy. Analysis of bronchoalveolar lavage fluid revealed a cell count
In India, 20million workers are involved in the manufacturing of 5
of 2.26 10 /ml with 15% lymphocytes and 85% macrophages. No
textiles.1 Byssinosis is caused by the inhalation of cotton, jute, flax and histopathological features5 characteristic of Byssinosis such as mucus
hemp fibers. It is a type of hypersensitivity pneumonitis. Byssinosis gland hyperplasia and infiltration of neutrophils into the bronchi were
is characterized by acute breathlessness, cough, and wheeze, typically seen.6,7 There was also no eosinophilic infiltration (reflecting allergy)
on Monday mornings following a weekend away from the workplace; in the biopsy specimens. High-resolution CT scan (mediastinal
symptoms decrease during the work week despite continued exposure. window) shows diffuse mild pleural thickening on both sides (Figure
The prevalence and severity of symptoms and functional impairment 2A) (Figure 2B). High-resolution CT scan (lung window) shows
are proportional to the duration and intensity of exposure.2 Although thickened intralobular and interlobular lines, hazy patches of increased
the pathogenesis of Byssinosis is unclear, the disorder shares some attenuation, bilateral small cysts predominantly in peripheral and sub-
features with hypersensitivity pneumonitis: Both frequently occur pleural distribution with associated traction bronchiectasis, and areas
after exposure to dust, and affected patients improve rapidly without of ground-glass attenuation (Figures 3A‒3E). A diagnosis of cotton
therapy.2,3 There have been only a few reports of pulmonary fibrosis dust pneumoconiosis was suggested by occupational exposure and a
and pneumoconiosis due to cotton dust.4 bronchiolocentric distribution of lung changes on the HRCT scan.
Case report
A 36year-old male with history of smoking and a pack year of
10, presented with symptoms of persistent dry irritating cough with
gradually increasing intensity for the past 18months becoming
spasmodic, with production of small quantities of sticky, tenacious
sputum. He also had progressive breathlessness for 18months and has
history of repeated episodes of fever. These symptoms are aggravated
when he returned to work after weekends and vacations. There was
no history of haemoptysis, joint pain or skin rashes. He was working
in Cotton factory 8-10hours/day for past 6years, and was involved in
the making of cotton mattress and blankets. Although cotton fibers
were often floating in the atmosphere of the workroom, no respiratory Figure 1 Chest radiograph shows diffuse, ill-defined haziness, predominantly
protection for the dust was provided. On clinical examination, the in the lower lung zones.
patient had Modified Medical Research Council (MMRC) dyspnoea
scale of 2 and hypoxemia with a saturation of 81% at room air. On
examination of the chest, there was vesicular breath sounds in both
lung fields with scattered fine crackles. Chest radiograph shows
diffuse, ill-defined haziness, predominantly in the lower lung zones
(Figure 1).
Serological tests showed no evidence of collagen disease. Arterial
blood gas analysis revealed a pH of 7.474, PaCO2 of 36.2 mm Hg, and
PaO2 of 56.2mm Hg. Lung function tests gave the following results:
vital capacity 1.26 l (38% of predicted), forced expiratory volume in
1 second/forced vital capacity (FEV1/FVC) 94%, peak expiratory
flow 4.74 l/min (58% of predicted), and carbon monoxide transfer
factor (TLCO) 5.53ml/min/mm Hg (19% of predicted) suggesting
Figure 2(A&B) High-resolution CT scan (mediastinal window) shows diffuse
severe restriction. Maximal mid expiratory flow was 2.76 l/s (76%
mild pleural thickening on both sides.
of predicted) and 25% forced expiratory flow was 4.61l/s (61% of
Submit Manuscript | http://medcraveonline.com Clin Med Images Int J. 2018;1(3):64‒66. 64
© 2018 Menon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and build upon your work non-commercially.
Copyright:
Diffuse lung disease caused by cotton dust exposure ©2018 Menon et al. 65
Figure 3(A‒E) High-resolution CT scan (lung window) shows thickened intralobular and interlobular lines, hazy patches of increased attenuation, bilateral
small cysts predominantly in peripheral and sub-pleural distribution with associated traction bronchiectasis, and areas of ground-glass attenuation.
Discussion tests also showed the severe restriction. X-ray and HRCT showed
features consistent with Byssinosis.
Some occupational lung diseases have characteristic radiologic
features suggesting the diagnosis while others do not. In such diseases, Acknowledgements
definite diagnosis cannot be made on the basis of imaging features
alone, but a combination of clinical features with related occupational None.
history and radiologic findings can significantly improve diagnostic
accuracy. The patient described here had symptoms of Byssinosis
Conflict of interest
(cough, breathlessness and Monday morning fever). The lung function Author declares that there is no conflict of interest.
Citation: Menon B, Mrigpuri P, Tiwari M, et al. Diffuse lung disease caused by cotton dust exposure. Clin Med Images Int J. 2018;1(3):64‒66.
DOI: 10.15406/cmiij.2018.01.00016
Copyright:
Diffuse lung disease caused by cotton dust exposure ©2018 Menon et al. 66
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Citation: Menon B, Mrigpuri P, Tiwari M, et al. Diffuse lung disease caused by cotton dust exposure. Clin Med Images Int J. 2018;1(3):64‒66.
DOI: 10.15406/cmiij.2018.01.00016
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