Dark Airway Pigmentation in a Copper Miner

Fernandez-Bussy, Sebastian; Labarca, Gonzalo; Majid, Adnan

doi:10.1016/j.arbres.2018.06.015

Archivos de Bronconeumología

ISSN: 0300-2896

Archivos de Bronconeumologia is an international journal that publishes original studies whose content is based upon results of research initiatives dealing with several aspects of respiratory medicine including epidemiology, respiratory physiology, pathophysiology of respiratory diseases, clinical management, thoracic surgery, pediatric lung diseases, respiratory critical care, respiratory allergy and translational research. Other types of articles such as editorials, reviews, and different types of letters are also published in the journal. Additionally, the journal expresses the voice of the following scientific societies: the Spanish Respiratory Society of Pneumology and Thoracic Surgery (SEPAR; https://www.separ.es/), the Latin American Thoracic Society (ALAT; https://alatorax.org/), and the Iberian American Association of Thoracic Surgery (AIACT; http://www.aiatorax.com/).

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A 68-year-old man referred to pulmonary consult with a 6-month history of increase shortness of breath and dry cough. He has worked in a copper mine north of Chile for almost 40 years. On physical examination, breath sounds were reduced bilaterally along with mild crackles. Laboratory studies revealed erythrocytosis with hematocrit 54% and hemoglobin 18.5g per deciliter (reference range, 13.5–17.5). Chest-CT scan showed mass-like lesions and bronchial narrowing in both upper lobes. Flexible bronchoscopy demonstrated mucosa dark pigmentation from both main stem bronchi and bronchus intermedius together with segmental bronchi obliteration of both upper lobes (Fig. 1A and Video). Bronchial mucosa biopsy revealed coal dust and acicular crystalline material observed under polarized light (40×) (Fig. 1B). Anthracofibrosis results from carbon particles deposition but other organic and inorganic substances,1,2 like silica in this case, can also cause this pigmentation.2 Commonly reported radiological features includes central peribronchial soft tissue thickening, intraparenchymal peribronchial cuffing or bronchial narrowing, such our case.1 Definitive diagnosis included a bronchoscopic examination that revealed a dark pigmentation in airway and biopsy samples revealed infiltration of non-specific mononuclear inflammatory cells, mostly polymorphonuclears with a normal epithelium.2 Unfortunately, there is no treatment for this condition rather than avoid exposure.

Fig. 1.

(a) Flexible bronchoscopy shows extensive dark airway pigmentation with bronchial obliteration of both upper lobes. (b) Bronchial mucosa biopsy demonstrates silica crystalline material under polarized light (40×).

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Appendix A

Supplementary data