Gülden Sarı

Background: Pneumoconiosis, particularly when complicated by progressive massive fibrosis (PMF), is characterised by complex radiological patterns that may overlap with malignancy, infection, and vascular disease. Such overlap frequently generates diagnostic uncertainty and may lead to delayed recognition of coexisting conditions or inappropriate management strategies. Despite these challenges, the literature remains largely fragmented and dominated by isolated case reports. Objective: This narrative review aims to synthesise current evidence on diagnostic pitfalls encountered in pneumoconiosis and to illustrate recurrent clinical and radiological challenges through selected cases from occupational lung disease practice. Methods: A structured review of the literature was undertaken focusing on malignancy, infectious complications, and thromboembolic disease in the setting of pneumoconiosis and PMF. To contextualise these findings, representative illustrative cases from real-world occupational medicine practice are integrated to highlight common diagnostic patterns and sources of misclassification. Key findings: Mass-like opacities, cavitary lesions, vertebral involvement, and increased metabolic activity on FDG–PET imaging may occur in both benign fibrotic progression and serious coexisting conditions. Lung cancer, lymphoma, tuberculosis (including extrapulmonary forms), fungal colonisation, and pulmonary thromboembolism may closely mimic PMF progression. Radiological features such as cavitation or FDG uptake lack sufficient specificity when interpreted in isolation. Conclusion: PMF should not be regarded as a comprehensive explanation for new or evolving radiological findings in patients with pneumoconiosis. A multidisciplinary approach integrating longitudinal imaging, advanced radiological techniques, and targeted tissue sampling is essential to avoid diagnostic oversimplification and to optimise clinical decision-making in occupational lung disease.

Background: Coal workers’ pneumoconiosis (CWP) is a parenchymal lung disease resulting from the prolonged inhalation of coal dust. Coal dust exposure may also lead to a spectrum of airway and parenchymal disorders. This study aimed to investigate the clinical characteristics, radiological and functional findings of CWP, as well as the presence of interstitial changes and associated risk factors. Methods: Patients with CWP who were admitted to the occupational diseases clinic of a tertiary hospital between 2017 and 2023 were included. Demographic, radiological, and pulmonary functional data were analyzed. High-resolution computed tomography scans were reviewed for interstitial lung abnormalities (ILA) and interstitial lung disease (ILD). Factors associated with ILD were assessed using logistic regression analysis. Statistical significance was defined as p<0.05. Results: A total of 100 male patients with CWP (mean age, 61.7 ± 11.7 years) were evaluated. Large opacities were present in 37% of cases. Pulmonary function testing revealed restrictive impairment in 35% and obstructive impairment in 38%of patients. Compared with those working lignite mines, bituminous coal miners exhibited a significantly higher prevalence of large opacities and lower lung function values. ILAs were identified in 63% of patients and ILD in 42%. ILD prevalence was significantly higher among those with exposure durations exceeding 10 years, working in bituminous coal mines, and with predominant small opacities larger than 3 mm. Conclusions: Coal dust exposure represents a major risk factor not only for CWP but also for lung function impairment, ILA, and ILD. Comprehensive surveillance of coal workers is essential for early detection and timely management of these conditions.

Silicosis is the most common occupational lung disease and association with Mycobacterium tuberculosis infection is common. Although extrapulmonary tuberculosis cases are rare, skeletal tuberculosis is responsible for 10-35% of these cases. Pott's disease is the most common form of skeletal tuberculosis, but it is not commonly encountered today. A 49-year-old male patient presented to our clinic with complaints of back pain, leg pain, and weight loss for 9 months. His occupational history revealed that he worked as a dental technician and a sandblasting for 30 years. In 2002, he was diagnosed with pneumoconiosis. Thoracovertebral Computed Tomography and Magnetic Resonance Imaging showed lytic lesions in the anterior middle columns of the T6-T9 vertebrae and an anterior narrow angle kyphosis (Gibbus deformity) at the level of T9 vertebra. The findings were primarily evaluated in favor of Pott's disease abscess. Posterior segmental instrumentation and osteotomy were performed. The patient was evaluated as extrapulmonary tuberculosis, and anti-tuberculosis treatment was started. We present a case of pneumoconiosis with extrapulmonary tuberculosis and Pott's disease.

This study aimed to evaluate the prevalence and risk factors of small airway dysfunction (SAD) in patients with pneumoconiosis and to emphasize its role in early stage and disease monitoring. Data including demographics, ILO pneumoconiosis classification, and pulmonary function tests were analyzed. SAD was defined by at least two pulmonary function parameters-maximal mid-expiratory flow (MMEF), forced expiratory flow at 50% (FEF50), and 75% (FEF75)-below 65% of predicted values. SAD was identified in 59% of patients (n = 118). Compared to stage 1, the risk of SAD was fourfold higher in stage 2 (p = 0.037, OR = 4.119) and nearly 14-fold higher in stage 3 pneumoconiosis (p = 0.008, OR = 13.714). Progressive massive fibrosis increased SAD risk by nearly seven times (p = 0.010, OR = 6.884). These results highlight that SAD is common and may occur early in pneumoconiosis, underscoring its importance in patient monitoring protocols.

Background: Pneumoconiosis remains a significant cause of morbidity and mortality worldwide and there is no known effective treatment for the disease. Therefore, preventing progression of pneumoconiosis is crucial. Aims: This study aims to evaluate the radiological progression of pneumoconiosis cases and identify factors influencing progression over a 5-year follow-up period. Methods: The study included pneumoconiosis cases that presented to the occupational diseases’ clinic of a teaching and research hospital between 2014 and 2024, and for whom radiological imaging and functional assessments were available both at the time of initial diagnosis and at the fifth year. The chest X-rays of patients at initial diagnosis and at 5 years were evaluated by two ILO pneumoconiosis readers for radiological progression. Factors affecting progression were examined using univariate and multivariate logistic regression analyses. A P-value of <0.05 was considered statistically significant. Results: Of the 759 patients, 131 cases with control evaluations available at the fifth year were included in the study. Radiological progression was detected in 68 cases (52%). Significant differences between the progression and non-progression groups were found for the following factors: age, smoking status, occupational groups, type of pneumoconiosis, pneumoconiosis severity and the dominant small opacity size. Logistic regression analysis identified smoking and working in the ceramics industry as independent risk factors for the development of progression. Conclusions: In the follow-up, more than half of the pneumoconiosis cases showed progression. Identifying factors associated with progression will be beneficial in reducing morbidity and mortality related to the disease.

Occupational cancers are cancers that result from exposure to carcinogens at work. Diagnosing occupational cancer expresses great importance in terms of public health. Because all occupational cancers are preventable as other occupational diseases. A detailed occupational history and careful questioning of exposure factors enable early diagnosis and prevention of occupational cancer. It is known that thyroid and skin cancers may occur due to occupational exposures. In this report, the coexistence of occupational thyroid cancer and occupational basal cell skin carcinoma is presented.

The prevalence of depression, anxiety, and burnout syndrome in healthcare workers is so high that it can’t be underestimated, because of the intense workload, shift work, night shifts, and problems encountered during working hours. This study was planned to evaluate the factors related to anxiety, depression, and burnout levels of healthcare professionals working in a training and research hospital. This descriptive study included 196 health care workers working in the hospital. Statistical analysis of the categorical data was performed by Chi-square test. Statistical analysis of quantitative data was performed by Mann Whitney U test and by Kruskal Wallis variance analysis because it did not fit normal distribution. In this study, the frequency of depression was found to be 24.0% in healthcare workers and the frequency of anxiety was 29.6%. It was determined that the presence of depression was more common in night and shift workers. Anxiety was statistically higher in health workers with chronic diseases and sleep problems. Compared to other health workers, it was found that the emotional exhaustion and depersonalization levels of the Maslach burnout scale sub-headings were higher in physicians.These results are very important in terms of identifying psychosocial risk factors in health workers and forenlightening to improve working conditions.

Objective: Pneumoconiosis is an irreversible, progressive parenchymal lung disease caused by inhalation of mineral dust. Inhaled particles in the working environment can cause inflammation and fibrosis in the lung, affecting all respiratory tracts, including the large and small airways. Our study aimed to evaluate the frequency and risk factors of small airway dysfunction (SAD) in patients diagnosed with pneumoconiosis. Methods: The study population consisted of 331 patients diagnosed with pneumoconiosis between 01/01/2018 and 31/05/2023. Pneumoconiosis was diagnosed with a history of occupational inorganic dust exposure, radiologic findings compatible with pneumoconiosis, and exclusion of other diagnoses. Two readers evaluated the chest radiographs of the patients according to the International Classification of Pneumoconiosis Radiographs of the International Labor Organization. SAD was defined as at least two FEF50, FEF75, and FEF25-75 measurements below 65% of their predicted values. Results: SAD was found in 47.7% of the patients. There was a statistically significant difference between age and the prevalence of SAD, but there was no statistically significant difference between smoking status and the prevalence of SAD. It was observed that 41.9% of the patients with pneumoconiosis who had never smoked had SAD. As the cigarette pack-years increased, the incidence of SAD increased. SAD was presented 38.7% in Stage 1, 50.7% in Stage 2, and 57.6% in Stage 3 pneumoconiosis cases. SAD was seen in 35.1% of pneumoconiosis cases without PMF. In pneumoconiosis patients with PMF, the frequency of SAD increased with increasing opacity size. Conclusion: It was found that the frequency of SAD increased as the stage of pneumoconiosis increased. In patients with pneumoconiosis, SAD was observed in both smokers and never smokers, independent of large airway obstruction. Therefore, early small airway dysfunction should be considered when monitoring the health of patients with pneumoconiosis.

Pneumoconioses are parenchymal lung diseases caused by dust accumulation in the lungs and the resulting tissue reaction. A 75-year-old male patient presented with the complaints of fatigue and shortness of breath for 6 months. In his professional history, it was learned that when he was 18 years old, he worked in a lead mine blasting with dynamite for 4 months, and then worked in tunnel and road construction, blasting, sand screening and transportation for 3 months. According to the International Labor Organization (ILO) International Classification of pneumoconiosis radiographs, the chest radiograph was r/q 2/2 + A2. In his history, it was learned that he applied to our hospital with the complaint of bloody sputum in 1982, open lung biopsy was performed for tuberculosis and malignancy, and the biopsy was reported as fibrotic lung tissue. We presented a case of pneumoconiosis presenting with bilateral pleural effusion accompanied by pulmonary thromboembolism.

Non-Hodgkin Lymphoma (NHL) is the most common hematological malignancy, and Diffuse Large B-Cell Lymphoma (DLBCL) is the most common histological type. A 56-year-old male patient was admitted to our clinic with complaints of shortness of breath and fatigue for 1 month. It was learned in his professional history that he had been a dental technician for 30 years. He was diagnosed with pneumoconiosis in 2020 and his chest radiograph was q/t 3/3 according to the International Labor Organization (ILO) International Classification of pneumoconiosis radiographs. Laboratory examinations revealed an increase in erythrocyte sedimentation rate (ESR 50 mm/h) and serum lactate dehydrogenase (LDH 368 IU/L) levels. On thoracic computed tomography (CT), enlarged lymph nodes and lymphadenopathies (LAP) with local conglomeration and calcifications in the mediastinal, subcarinal and bilateral hilar areas were seen. Widely disseminated inhomogeneous mass-like consolidation areas, including internal calcifications, extending from the hilum to the parenchyma in both lungs, were observed more prominently in the right middle zone. Diffuse interstitial thickenings, infiltrations and centrilobular nodular density increases in both lungs, nodular consolidated areas with recessed contours and nodules and ground glass densities were observed, especially in the left upper zone. In the lateral part of the left 5th rib, a heterogeneous soft tissue mass of approximately 12x5 cm, causing cortical destruction, invading the surrounding soft tissues and muscle planes, and containing internal cystic-necrotic components was observed. On abdominal CT, enlarged lymph nodes and LAPs, some of which contain calcifications, were observed in the abdomen. The pathology result was reported as Diffuse B-Cell Lymphoma in the patient who underwent transthoracic biopsy due to radiographic appearances that are not typical for PMF. Here, we presented a case of pneumoconiosis with occupational carcinogen exposure and presenting with lymphoma.