Talc: understanding its manifestations in the chest

Our plain-English summary of Talc: understanding its manifestations in the chest, by D.S. Feigin (AJR. American Journal of Roentgenology, 1986).

The study

• Author: D.S. Feigin
• Journal: AJR. American Journal of Roentgenology
• Published: 1986;146(2):295-301
• Cited by: 45 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001153).

Abstract

Four distinct forms of pulmonary disease caused by talc have been defined. The first form, talcosilicosis, is caused by talc mined with high-silica-content mineral. Findings in this form are identical with those of silicosis. Talcoasbestosis closely resembles asbestosis and is produced by crystalline talc, generally inhaled with asbestos fibers. Pathologic and radiographic abnormalities are virtually identical with those of asbestosis, including calcifications and malignant tumor formation. The third form, talcosis, caused by inhalation of pure talc, may include acute or chronic bronchitis as well as interstitial inflammation; radiographically, it appears as interstitial reticulations or small, irregular nodules, typical of small-airway obstruction. The fourth form, due to intravenous administration of talc, is usually associated with abuse of oral medications and production of vascular granulomas manifested by consolidations, large nodules, and masses. Radiographic abnormalities associated with talc can be predicted when there is sufficient history of the nature of exposure, including the region of origin of the talc in cases of inhalation. Radiographic changes, such as diaphragmatic plaques, often attributed to both talc and asbestos have not been documented to be caused by talc alone. The author provides review of 18 well-documented cases.

In plain English

This 1986 radiology article reviewed 18 cases of lung disease in adults (15 men and three women) whose lung biopsy or autopsy tissue contained talc. Most cases came from the archives of the Armed Forces Institute of Pathology, and each had a documented exposure history. The author sorted the cases into four forms. Three cases of talcosilicosis (talc with silica) looked like silicosis. Four cases of talcoasbestosis involved talc mined in or near New York State, where talc occurs with large quantities of asbestos. All four showed talc and asbestos particles in the lungs and bilateral pleural plaques. Two had calcified diaphragmatic plaques, and asbestosis was definitely present in two and questionably in one. Four cases of pure talc inhalation, from Vermont and California, showed small nodules and reticulations but no calcifications or distinct pleural plaques. Seven cases from injecting crushed oral medications showed granulomas around blood vessels. Smoking histories were generally not detailed enough to compare with the other findings. The author concluded that talc alone has not been documented to cause the X-ray abnormalities or the malignancies well documented after asbestos inhalation.

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: Review of a series of 18 pathologically documented cases (case series), correlating chest radiographs, lung pathology and exposure histories
• Who was studied: 18 adults (15 men, 3 women) with talc found in the lungs at biopsy (11) or autopsy (7). Cases came mainly from the Armed Forces Institute of Pathology archives in Washington, DC, plus one from George Washington University Hospital and two from the University of California, San Diego. Dates of the cases are not given.
• Exposure: Talc exposure either by inhalation (talc from California, Italy, New York State including the Gouveneur region, and Vermont; some talc mixed with silica or asbestos) or by intravenous injection of ground-up oral medications, generally including pentazocine or methadone. The article does not name the asbestos fiber type found in its talcoasbestosis cases.
• Main results:
  • The 18 cases were classified as talcosilicosis (3), talcoasbestosis (4), pure talcosis from inhaling pure talc (4), and intravenous talc (7).
  • All 3 talcosilicosis cases had findings typical of exposure to silica alone.
  • All 4 talcoasbestosis patients had histologic evidence of both talc and asbestos particles producing lung disease.
  • All 4 talcoasbestosis patients had bilateral pleural plaques on radiographs.
  • In the talcoasbestosis group, true asbestosis was definitely present in 2 cases and questionably present in 1 more.
  • Calcified diaphragmatic plaques were clearly seen in 2 of the 4 talcoasbestosis patients.
  • In the 4 pure talcosis cases (Vermont and California talc), radiographs showed small nodules and reticulations. There were no calcifications, and distinct pleural plaques and effusions were absent.
  • In all 7 intravenous talc cases, granulomas with talc particles were found in and around blood vessels. Massive lymph-node enlargement was present in 4 of the 7.
• The authors' conclusion: The author concluded that talc alone has not been documented to produce the radiographic abnormalities or the malignancies that are well documented in asbestos inhalation.
• Limitations the authors state:
  • Smoking histories generally were not detailed enough to be useful for correlation with other findings.
  • More accurate mineral identification (scanning electron microscopy and x-ray microanalysis) was used only in the four most recent cases. All cases were examined by light and polarized microscopy.
  • The most precise method of measuring mineral content, x-ray spectrometry of homogenized large specimens, was not available for any case.
  • In the intravenous cases, some findings may have had other causes, such as infection, so not all radiologic findings can be definitively attributed to talc.
  • The origin of the talc in the injected oral medications was not documented.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Talc, Silicosis, Crystalline, Interstitial, Inflammation, Granuloma, Consolidation.

Related studies

• Pulmonary talc granulomatosis. A complication of drug abuse — G.B. Hopkins, D.G. Taylor (1970)
• Pulmonary granulomatous reaction: talc pneumoconiosis or chronic sarcoidosis? — P. Tukiainen, J. Nickels, et al. (1984)
• On talc, tremolite, and tergiversation. Ter-gi-ver-sate: 2: to use subterfuges — B.W. Case (1991)
• On talc, tremolite, and tergiversation — A.M. Langer, R.P. Nolan, et al. (1991)
• Chest wall tumour following iodized talc pleurodesis — J.W. Jackson, M.H. Bennett (1973)
• Exposure to asbestiform minerals and radiographic chest abnormalities in a talc mining region of upstate New York — E.F. Fitzgerald, A.D. Stark, et al. (1991)

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