Rheumatoid pneumoconiosis in association with asbestosis

Our plain-English summary of Rheumatoid pneumoconiosis in association with asbestosis, by W.K. Morgan (Thorax, 1964).

The study

• Author: W.K. Morgan
• Journal: Thorax
• Published: 1964;19(5):433-5
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002625).

In plain English

This was a case report about one man. He was a 49-year-old electric arc-welder of 20 years, admitted to Maryland General Hospital with cough and mild shortness of breath on exertion. His chest X-ray showed net-like and nodular shadows in the mid and lower zones, plus several rounded nodules in both lungs. He had no overt evidence of rheumatoid arthritis. A lung biopsy showed iron in the lung tissue like that seen in welders' siderosis, interstitial fibrosis (scarring), and numerous asbestos bodies. A later work history explained the asbestos: for many years he had welded pipes inside ships while the pipes were lagged with asbestos. A latex fixation blood test was positive to a dilution of 1:1,250. Lung tests showed increased lung volumes without significant airway obstruction, and a low carbon dioxide level. The author interpreted this as alveolar-capillary block. A pathologist, Professor Jethro Gough, considered it a further instance of Caplan's syndrome associated with asbestosis. The author stated that, so far as known, this was only the third such report.

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: case report
• Who was studied: One 49-year-old man admitted to Maryland General Hospital, Baltimore. He had been an electric arc-welder for 20 years.
• Exposure: Asbestos (fiber type not named). For many years he welded pipes in the interior of ships while the pipes were being lagged with asbestos. The author says this produced a 'snow storm' of asbestos fibres. He was also exposed to welding fumes (iron, welders' siderosis).
• Main results:
  • The chest radiograph of this patient showed reticulo-nodulation in the mid and lower zones and several discrete rounded nodules in both lung fields.
  • This patient had no overt evidence of rheumatoid arthritis. A later latex fixation test, however, was positive.
  • The lung biopsy showed iron as seen in welders' siderosis, interstitial fibrosis, and numerous asbestos bodies.
  • A latex fixation test in this patient was positive to a dilution of 1:1,250.
  • The patient's pulmonary function studies showed increased residual volume (1,400 ml predicted, 2,600 ml observed, 186%), increased functional residual capacity and increased total lung capacity, with no significant airway obstruction.
  • The patient's Pco2 at rest was 29 mm against a predicted 38 to 42 mm, with normal oxygen saturation. The author interpreted this as hyperventilation, most probably due to alveolar-capillary block.
  • Professor Jethro Gough, who reviewed the slides, considered the case a further instance of Caplan's syndrome associated with asbestosis.
• The authors' conclusion: The author concluded there was little doubt of the diagnosis (rheumatoid pneumoconiosis with asbestosis), given the positive serological findings and the characteristic histology. The author stated that, so far as known, this was only the third such reported case. The author also said the case shows how hazardous it is to suggest clinical or radiological diagnoses without adequate physiological and pathological studies.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Pneumoconiosis.

Related studies

• Rheumatoid pneumoconiosis (Caplan's syndrome) in an asbestos worker — W.G. Tellesson (1961)
• Rheumatoid "pneumoconiosis" (Caplan's syndrome) in an asbestos worker: a 17 years' follow-up — I.A. Greaves (1979)
• Talc pneumoconiosis: a report of six patients with postmortem findings — M. Kleinfeld, C.P. Giel, et al. (1963)
• Exposure to asbestos and mesothelioma of the pleura — P.B. Fowler, J.C. Sloper, et al. (1964)
• Peritoneal tumours in asbestosis — J.B. Enticknap, W.J. Smither (1964)
• Assessment of physicians' proficiency in reading chest radiographs for pneumoconiosis, based on a 60-film examination set with two factors constituting eight indices — T. Tamura, Y. Kusaka, et al. (2018)

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