Chalicosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Flint disease

Overview

Chalicosis (Greek, χάλιξ, gravel), also called Flint disease, is a disorder of the lungs or bronchioles (chiefly among stonecutters), due to the inhalation of fine particles of stones; it is a form of pneumoconiosis.

Historical Perspective

• The term chalicosis was first introduced by Merkel in 1870, for pneumoconiosis cases caused due to fine gravel or stone.
• Chalicosis is seen mostly in stonecutters.

Pathophysiology

The ciliated epithelium in the lungs, along with mucus secretions and phagocytes protect the airways from dust. When there is exposure to excessive dust, the epithelium is unable to arrest all the pigment, resulting in it's leakage into subpleaural and interbronchial tissues; and interspaces of alveoli. This results in an inflammatory response and release of tumor necrosis factors, interleukin-1, leukotriene B4 and other cytokines resulting in activation of fibroblasts to proliferate and produce collagen around the dust particle; which causes fibrosis and nodular lesions in the lungs.

Associated Conditions

• Hepatosplenic involvement is not uncommon with chalicosis.

Causes

• Inhalation of fine particles of stones.

Differentiating type page name here from other Diseases

• Should be differentiated from other diseases causing pneumoconiosis and those with similar presentation including: cough, dyspnea, pulmonary nodules and fibrosis on chest x-ray
• Silicosis
• asbestosis
• tuberculosis
• aspergillosis
• pulmonary malignancy.

Risk Factors

• Occupations with excessive exposure to stone dust like excavations in mines, mining of nonferrous metal ores, tunnels, quarries, underground galleries, dry cutting, grinding, sieving and manipulation of minerals and rock, foundry work, milling work, sandblasting and grinding, pottery industry.

Natural History

Chalicosis is a slowly progressive disease where it can take upto 10 years for the manifestations to occur.

Diagnosis

• Detailed occupational history should be obtained, including time of exposure to stone dust and measurement of respirable dust.
• Chest X-ray findings are similar to those of pneumoconiosis may include small rounded opacities, small irregular opacities, profusion of opacities, large opacities, zonal distribution of opacities (upper, middle, and/or lower), and pleural thickening (diffuse or circumscribed).
• Pulmonary function test: Decreased TLC, FVC, and DLCO , Normal FEV1 / FVC ratio

Symptoms

Dyspnea, dyspnea on exertion, chronic, non-productive cough may be present.

Physical Examination

Lungs:

• Crackles/rales and inspiratory wheezes maybe present

Other:

• Cyanosis
• Clubbing

Laboratory Findings

Chest X Ray

Chest X-ray findings are similar to those of pneumoconiosis may include small rounded opacities, small irregular opacities, profusion of opacities, large opacities, zonal distribution of opacities (upper, middle, and/or lower), and pleural thickening (diffuse or circumscribed).

Treatment

Pharmacotherapy

• Treatment of chalicosis consists of managing associated respiratory symptoms and comorbidities and complications (e.g. COPD or tuberculosis). There is no targeted therapy for chalicosis
• Management goals include avoidance of exposure to stone dust, optimization of respiratory function, and preventive care.

Acute Pharmacotherapies

• Systemic steroids may be used for acute management of symptoms.

Chronic Pharmacotherapies

• Systemic steroids are not recommended for chronic management.
• Supplemental oxygen is administered to prevent complications of chronic hypoxemia
• Bronchodilators if airflow limitation is present on spirometry.
• Smoking cessation

References

• Dorland's Medical Dictionary (1938)
• Pneumoconiosis by A Meiklejohn
• Pulmonary Fibrosis, Clifford R. Orr and William F. Jacobs, Radiology 1926 7:4, 318-325
• Springer International Publishing Switzerland 2017, A. Zimmermann, Tumors and Tumor-Like Lesions of the Hepatobiliary Tract, DOI 10.1007/978-3-319-26956-6_123
• Silicosis and Other Health Problems of Metal Miners , WALDEMAR C. DREESSEN, M.D., RICHARD T. PAGE, F.A.P.H.A., AND HUGH P. BRINTON, PH.D.,
• Pneumoconiosis: Comparison of Imaging and Pathologic Findings, Semin Chong, Kyung Soo Lee, Myung Jin Chung, Joungho Han, O Jung Kwon, and Tae Sung Kim, RadioGraphics 2006 26:1, 59-77