Atila EROĞLU, Metin AKGÜN, Yener AYDIN, Atila TÜRKYILMAZ, Hasan KAYNAR

Pneumothorax in the cases with silicosis due to denim sandblasting

Amaç: Bu çalışmada kot taşlama işine bağlı silikozisin akut ve hızlandırılmış formlarında seyreden sekonder spontan pnömotoraks olguları bildirildi. Çalışma planı: Çalışmaya son beş yıl içerisinde taşlanmış kot pantolonu üreten küçük işyerlerinde çalışan ve silikozise bağlı sekonder spontan pnömotoraks gelişen yedi erkek hasta (ort. yaş 20.4 yıl; dağılım 17-23 yıl) dahil edildi. Pnömotoraks tanısı tüm olgulara posteroanterior akciğer grafisi değerlendirmesi ile konuldu. Bulgular: Silika partiküllerine maruziyet süresi ortalama 3 4.4 ay (dağılım 2 4-48 ay) i di. Silikozis t anısı i lk olguda açık akciğer biyopsisi ile doğrulanırken, diğer hastalarda öykü, klinik ve radyolojik değerlendirmeler ile kondu. Hastaların hepsinde çeşitli derecelerde dispne ve göğüs ağrısı vardı. Pnömotoraks üç olguda sağ tarafta, iki olguda sol tarafta yerleşim göstermekte iken, iki olguda da iki taraflı idi. Tüm olgulara tüp torakostomi uygulanırken, iki olguya tetrasiklin ile plöredez uygulandı. Hiçbir hastada pnömotoraks nüksü gelişmedi. Sonuç: Çalışmamızda kot taşlamaya bağlı silikozisin akut ve hızlandırılmış formlarında sekonder pnömotoraks insidansının arttığı görülmektedir. Silikozise bağlı pnömotoraks ciddi morbidite ve mortaliteye neden olabilir. Silikozisin tedavisinin olmaması nedeniyle hastalığı önlemeye yönelik tedbirler alınması, silikozis ve pnömotoraksla başa çıkmada en önemli adımlardır.

Kot taşlamaya bağlı silikozis olgularında pnömotoraks

Background: This study aims to report secondary spontaneous pneumothorax cases, presenting in acute and accelerated forms of silicosis associated with working in sandblasting jobs. Methods: The study included seven male patients (mean age 20.4 years; range 17 to 23 years) with secondary spontaneous pneumothorax caused by silicosis, who worked in small workplaces producing sandblasted jeans within the past five years. In all cases, pneumothorax was diagnosed by posteroanterior chest X-ray evaluation. Results: The mean duration of exposure to silica particles was 34.4 months (range 24-48 months). In the first case, the diagnosis of silicosis was confirmed with an open lung biopsy, whereas in other patients, diagnosis was established by historical, clinical, and radiological evaluations. All of the patients had various degrees of dyspnea and chest pain. Pneumothorax was seen on the right side in three cases and on the left side in two cases, while bilateral pneumothorax was seen in two cases. Tube thoracostomy was performed in all patients, while pleurodesis with tetracycline was performed in two patients. None of the patients developed recurrent pneumothorax. Conclusion: Our study showed an increased incidence of secondary pneumothorax in acute and accelerated forms of silicosis due to denim sandblasting. Pneumothorax due to silicosis may cause serious morbidity and mortality. The most important steps to cope with silicosis and pneumothorax is to take preventive precautions, as the disease is incurable.

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1. Rees D, Murray J. Silica, silicosis and tuberculosis. Int J Tuberc Lung Dis 2007;11:474-84.
2. Akgun M, Gorguner M, Meral M, Turkyilmaz A, Erdogan F, Saglam L, et al. Silicosis caused by sandblasting of jeans in Turkey: a report of two concomitant cases. J Occup Health 2005;47:346-9.
3. Akgun M, Mirici A, Ucar EY, Kantarci M, Araz O, Gorguner M. Silicosis in Turkish denim sandblasters. Occup Med (Lond) 2006;56:554-8.
4. Akgun M, Araz O, Akkurt I, Eroglu A, Alper F, Saglam L, et al. An epidemic of silicosis among former denim sandblasters. Eur Respir J 2008;32:1295-303.
5. Gupta KB, Manchanda M, Kaur P. Bilateral spontaneous pneumothorax in silicosis. Indian J Chest Dis Allied Sci 2006;48:201-3.
6. Rao S, Rau PV. Bilateral spontaneous pneumothorax in silicosis. Indian J Chest Dis Allied Sci 1993;35:47-9.
7. Arora VK, Seetharaman ML, Veliath AJ. Silicotic alveolar proteinosis with bilateral spontaneous pneumothorax. J Assoc Physicians India 1992;40:760-2.
8. Parker JE, Petsonk EL. Coal workers’ lung diseases and silicosis. In: Fishman AP, Elias JA, Fishman JA, Grippi MA, Kaiser LR, Senior RM, editors. Fishman’s pulmonary diseases and disorders. 3rd ed. New York: McGraw-Hill; 1998. p. 901-14.
9. Aggarwal P. Silicotuberculosis. In: Sharma SK, Mohan A, editors. Tuberculosis. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2004. p. 181-6.
10. Mohebbi I, Hassani E, Salarilak S, Bahrami AR. Do bullae and emphysema increase risk of pneumothorax in silicosis? J Occup Med Toxicol 2007;2:8.
11. Türkyılmaz A, Erdem AF, Aydın Y, Çinici Ö, Eroğlu A. Treatment of secondary spontaneous pneumothorax: 100-patient experience. EAJM 2007;39:97-102.
12. Wilt JL, Banks DE, Weissman DN, Parker JE, Vallyathan V, Castranova V, et al. Reduction of lung dust burden in pneumoconiosis by whole-lung lavage. J Occup Environ Med 1996;38:619-24.