Silicosis

"Silicosis was first reported by the ancient Greeks and is apparently as old as human history. The prevalence of this illness peaked in the last half of the 19th century and the early part of this century, when mechanized industry was developing and the relationship between dust exposure and disease was less well understood. Yet, even today in devel-oped countries, sporadic outbreaks of silicosis occur when workers are consistently exposed to silica particles of respir-able size (0.5 to 5.0 µm in diameter) at levels exceeding those recognized to be safe.Silicon dioxide or silica. is the earth's most abundant mineral. Silica is considered to be either free (i.e.. unbound to other minerals) or combined. Minerals with high amounts of free silica include quartz (including granite) flint. Chert, opal, chalcedony, and diatomite. Combined forms of silica are called silicates and include, among others, asbestos talc and kaolin.In the crystalline form, silica exists as quartz, cristobalite, and tridymite (Fig. 28). Of these quartz is ubiquitous in the environment and occurs as sand and as a part of many rocks. Cristobalite and tridymite occur naturally in lava and can be formed by the heating of quartz or amorphous silica. Cristo-balite is more tibrogenic than quartz. Amorphous silica is noncrystalline and, therefore, is relatively nontoxic and does not cause silicosis. It occurs as diatomite (skeletons of pre-historic marine organisms) or as vitreous silica (glass), the result of carefully melting and then quickly cooling free crystalline silica. Heating diatomite with or without alkali (a process known as calcining), forms cristobalite and adds the respiratory toxicity of free crystalline silica.There are many opportunities for occupational exposure to respirable crystalline free silica. Some of the commonly en-countered occupations in which the risk of silicosis exists are reported in Table 20.Silicosis. the pulmonary disease caused by the inhalation of silica particles of respirable size, is most commonly cate-gorized by findings on the chest radiograph. The most typical presentations simple silicosis and progressive massive fibrosis appear different radiologically but are grouped under the category of classic silicosis because they are a part of the radiographic spectrum of this illness. Radiographically, simple silicosis appears as small (less than 10 mm in diameter), rounded opacities, typically predominant in the upper lung zones. Progressive massive fibrosis is the result of the coalescence of these small nodular opacities and appears as larger opacities (more than 10 mm in diameter), again typicallydistributed in the upper lung zones."