Silicosis

Introduction to silicosis Silicosis is a systemic disease in which pulmonary fibrosis is the main disease caused by long-term inhalation of a large amount of dust particles containing free silica (SiO2) in a production environment. Free silica is mainly present in quartz, and SiO2 accounts for 97% to 99% of the quartz component. About 70% of the ore contains more SiO2. Workers who have been engaged in mining, quarrying, tunneling, and production in quartz powder mills, glass mills, refractory plants, ceramics factories and enamel factories are prone to this disease. Silicosis is one of the most serious occupational diseases. It is characterized by slow development and the disease continues to develop slowly even after it is removed from the dusting operation. Most patients are sick after 10 to 15 years of exposure to silica. If you inhale a high concentration, high free silica content of the dust, after 1 to 2 years of onset, called instant hair silicosis. There is lung damage in the early stage of silicosis, but due to the strong compensatory capacity of the lungs, patients are often asymptomatic. With the development of the lesions, especially with tuberculosis and pulmonary heart disease, there are gradually varying degrees of respiratory and cardiac dysfunction. . Silicosis is one of the most serious types of pneumoconiosis caused by long-term inhalation of dust containing free silica (SiO2). There is extensive nodular fibrosis in the lungs, which seriously affects lung function and loses labor capacity. basic knowledge The proportion of illness: 0.001% Susceptible people: people with more dust in their work environment Mode of infection: non-infectious Complications: chronic obstructive pulmonary disease chronic pulmonary heart disease emphysema spontaneous pneumothorax hemoptysis

Silicosis

Cause (90%):

Silicosis is still the most serious pneumoconiosis. Once silicosis occurs, it can progress slowly even if it is out of contact. So far, there is no satisfactory treatment. Silicosis can cause loss of labor capacity, but if there is no complication after contact with dust, the patient can still For a long time of survival, the incidence of silicosis is the highest in pneumoconiosis. The severity of silicosis depends on three factors: the concentration of dust in the air, the content of free silica in the dust and the contact time. In addition, protective measures and individual factors such as individuals Habits (smoking), upper and lower respiratory diseases have certain effects in the development of silicosis.

Pathogenesis

After the free silica particles enter the alveoli, they are engulfed by pulmonary macrophages that accumulate at the beginning of the lymphatic vessels of the lungs. The free silica has a strong toxic effect on macrophages, which can cause autolysis and death. After being phagocytosed, silicon is encapsulated in phagocytic lysosomes, which form hydrogen bonds between the hydroxyl groups on the quartz surface and the hydrogen atom receptors (oxygen, nitrogen and sulfur atoms) on the macrophage lysosomal membrane lipoprotein structure. Causes changes in cell membrane and changes in permeability, leading to macrophage lysosomal disintegration, and release of acidic hydrolase into the cell, which in turn leads to the death of macrophages, and releases the quartz particles again, forming a vicious circle, resulting in a vicious circle. More cell damage, damaged macrophages release non-lipid "fibrotic factors", stimulate fibroblasts, leading to collagen fibrosis, forming a focal nodule centered on collagen fibers - sputum nodules The sacral nodules expand and fuse with the whole lung, causing diffuse damage to both lungs. Fibrosis is not limited to the lungs, but also exists in the lymph nodes to which macrophages migrate. In many silicosis patients, It is found that the serum -globulin level is increased, the presence of autoantibodies, and the presence of -globulin in silicosis, so the immunological mechanism of silicosis is proposed, but the immune components do not appear to be involved in the killing and fibrosis of macrophages. Formation, and therefore a secondary pathogenesis.

The sacral nodule is a characteristic lesion of silicosis, accompanied by diffuse pulmonary interstitial fibrosis. The sacral nodule is usually located around the bronchus and blood vessels, with a diameter of 0.3-1.5 mm. The gross specimen is gray-brown with a hard texture. The volume is increased, the weight is increased, the surface is sandy or hard, and the section can be seen with nodules or lumps of different sizes. The boundary is clear and the texture is dense. There is emphysema in the lung tissue around the nodules. Usually the whole lung is diffuse. Distribution, local lymph nodes in the pleura and outside are often involved, calcification or formation of tendon nodules.

Under the microscope, the sacral nodules are round or star-shaped, and the center is composed of collagen fibers that have undergone hyaline degeneration. The collagen fibers are arranged in concentric circles. There are different proportions of reticular fibers around the nodules, macrophages, and fibrils. The cells and plasma cells are surrounded by halo, the larger the halo is, and the more active the lesion is, the polarized light microscope can be used to identify the quartz particles in the sacral nodules and deposited in the lung tissue.

The hilar lymph node is the earliest part of the sputum reaction. It can enlarge the lymph nodes before the sacral nodules are seen on the chest radiograph. The gross specimens can be seen with lymphadenopathy, adhesions, histological findings similar to the lungs, and visible in the lymph nodes. Scattered non-necrotic granulomas, with fibrotic changes as the lesion progresses, lymph node lesions may be more important than lung tissue changes in typical tendon nodules and severe interstitial fibrosis.

Silicosis prevention

The key to control and reduce silicosis is prevention. Prevention is firstly to reduce the dust in the working environment. China's national standards stipulate that the maximum allowable concentration of 50% to 80% free silica dust in the air of the workshop is 1.5mg/m3, and the air in the workshop contains 80%. The maximum allowable concentration of free silica dust above 1% is 1mg/m3. To this end, industry management should be strengthened, strict sanitary supervision and environmental monitoring systems should be established, and dust-proof mechanisms should be established and improved, including regular monitoring of dust systems and evaluation of dust-proof measures. The effect, starting from technical measures, grasping the process reform, from the production process, the process basically eliminates the generation of dust, such as replacing quartz with non-defective materials, strengthening wet work, strengthening airtightness, ventilation, dust removal, so that wet work can not be used. The process is carried out in a closed system to prevent dust from flying, strengthen publicity and education, develop a health cleaning system, achieve civilized production, do pre-employment and regular physical examinations, and regularly take chest radiographs. Regular follow-up should also be carried out for those who have been removed from dust. For those with upper respiratory tract disease, bronchopulmonary disease, especially those with tuberculosis, cardiovascular disease Silica dust caught shall not engage in operations, enhance personal protection, personal hygiene, physical exercise, pay attention to nutrition.

Silicosis Complications Chronic obstructive pulmonary disease Chronic pulmonary heart disease Emphysema Spontaneous pneumothorax hemoptysis

The main complications of silicosis are: tuberculosis, respiratory insufficiency and pulmonary infection, chronic obstructive pulmonary disease, pulmonary heart disease, and right heart failure, which are also the most common causes of death.

1. Tuberculosis

In pneumoconiosis, silicosis is most likely to be associated with tuberculosis, often with the progress of silicosis, the merger rate is also increased, often the cause of direct death in silicosis patients, accounting for almost 40% to 50%, in the early stage of tuberculosis, in the X-ray chest It is often difficult to find any changes on the film, the patient can be asymptomatic; later symptoms gradually appear, sometimes hemoptysis, a rapid change on the chest X-ray, a large piece of cheese-like change with a cavity, if the disease is at rest, or already After treatment, only fibrous scars remain. X-ray chest radiographs have emphysema in the fibrotic area near the scar. Many silicosis mass lesions are often developed on the basis of tuberculosis. Therefore, patients with silicosis should have regular sputum smear. If necessary, when the X-ray film changes faster, regardless of its size, it should be used for sputum culture. Simple silicosis should be free of symptoms such as fever unless there is infection and rapid development of the case. The series of toxicity symptoms are of great significance for the differential diagnosis of silicosis and silicosis.

2, lung infection

Silicosis in patients with silicosis, as well as diffuse fibrosis of the lungs, resulting in bronchoconstriction, poor drainage, easy to cause bacterial and viral infections, lung infections often promote the development of silicosis, and easily induce respiratory failure and death, prevent respiratory infections for silicosis Patients, especially advanced patients, are important, and once infected, they should be actively treated, controlled by infection, prevented from prolonged lesions, and died of respiratory failure.

3, spontaneous pneumothorax

Patients with advanced silicosis often have obstructive and compensatory emphysema, and there are pulmonary bullae. In the case of severe cough or exertion, the lung vesicle ruptures, spontaneous pneumothorax can occur, and pleural adhesion often occurs during silicosis, so the pneumothorax is often localized. And self-absorption, but can occur repeatedly, due to the extreme decline in lung function in patients with advanced silicosis, once the pneumothorax is not treated, it can lead to death.

4. Chronic pulmonary heart disease

When the lungs are fibrillated, the fibrous tissue around the blood vessels proliferates, forming a blood vessel or a blood vessel-centered tendon nodule, causing the blood vessel to be distorted and deformed. At the same time, due to the fibrosis of the blood vessel wall itself, the blood vessel wall is further narrowed or even occluded, and the damage of the small artery is further Obviously, the pulmonary capillary bed is reduced, the blood flow resistance is increased, and the right heart burden is aggravated. If the disease continues to progress, it can lead to pulmonary heart disease, especially when secondary respiratory infections often lead to heart failure and respiratory failure, becoming silicosis. The main cause of death in patients with advanced disease.

Silicosis symptoms Common symptoms Breathing difficulties Chest pain Breathing sounds prolong lung fibrosis Sound loss of appetite Qip breath sounds weakened barrel chest with bloodshot

Patients with silicosis are generally asymptomatic or have no obvious symptoms at an early stage. As the lesion progresses, the symptoms increase. The main manifestations are as follows:

According to the dust concentration, the dust content and the dust collection period are divided into three types: chronic silicosis, acute silicosis and accelerated silicosis between the two.

In the early stage of the disease, patients with silicosis are often asymptomatic or have no obvious symptoms. Even if there are obvious signs on the chest X-ray, they can still have no performance. Only when they have regular physical examinations or chest radiographs for other reasons, they have been found in the lungs. The typical sputum nodules have changed, and even the changes of stage II silicosis have been reached. As the disease progresses or there are comorbidities, different degrees of symptoms may occur. The severity of the symptoms is often not completely parallel with the extent of the lesions in the lungs.

1. Difficulty breathing: In order to gradually develop dyspnea with slow progress, after the activity, the patient feels poor or chest pressure. When exerting force, it appears later when it is slightly stressed. Symptoms, mostly due to pulmonary fibrosis, especially due to emphysema, can also be caused by co-infection, the presence and severity of shortness of breath and the extent of lung function damage and X-ray findings are not necessarily parallel, advanced patients with dyspnea can be extremely serious It is also short-lived when you are slightly active or even resting. You cannot lie flat.

2, cough, cough: a history of smoking, may be accompanied by cough, cough and other bronchitis symptoms, cough mainly in the morning, sometimes day and night break, often persistent cough, may be due to tracheal and endobronchial nerve The receptor is caused by the stimulation of the nodular mass, no flaws, or only a small amount of sticky, purulent sputum may appear in the secondary infection, cough is aggravated, simple silicosis and hemoptysis are rare, generally no wheezing, unless there is chronic In bronchitis or allergic asthma, some patients are fixed due to tracheal stenosis, distortion, and fibrosis, especially in advanced patients or when breathing hard.

3, hemoptysis: occasional hemoptysis, usually with bloodshot sputum, combined with tuberculosis and bronchiectasis, repeated hemoptysis, and even large hemoptysis.

4, chest tightness, chest pain: mostly in the upper chest acupuncture-like pain, or persistent pain, often appear in rainy days or climate changes, and breathing, exercise, body position has nothing to do.

5, systemic damage: not obvious, unless there is tuberculosis or congestive heart failure, those with shortness of breath should be suspected of having severe emphysema or extrapulmonary disease at rest, in addition to respiratory symptoms, patients with advanced silicosis often have appetite Decreased, physical weakness, weight loss, night sweats and other symptoms.

Signs:

Early silicosis has many signs, advanced patients may have signs of chronic obstructive pulmonary disease: such as barrel chest, percussion has been unvoiced, auscultation exhalation sound is prolonged, respiratory sounds are weakened, etc., when the infection is combined, both lungs can hear dry and wet Sound, a series of corresponding signs can be seen in the late stage of pulmonary heart disease with heart failure.

Silicosis examination

The blood of the silicosis patients, urine routine examination mostly in the normal range, the late sputum erythrocyte sedimentation rate can be increased, blood sputum, urinary sputum measurement fluctuation range, silicosis patients serum albumin decreased, globulin increased, with alpha globulin and gamma globulin increased More common.

In recent years, bronchoalveolar lavage has been widely promoted and applied as a method for the diagnosis and treatment of pneumoconiosis. By detecting the cellular components, biochemical immunity and etiological characteristics of bronchoalveolar lavage fluid (BALF), the pneumoconiosis Auxiliary diagnosis and differential diagnosis are also of great value. The total number of cells in the normal non-smoker BALF (5-10) × 106, of which macrophages (AM) account for about 95%, lymphocytes <5%, neutrophils and Acidic granulocytes <1%, lymphocytes in BALF can be increased by 40% to 60% in acute silicosis patients, PaCO2 is more abnormal, but when there is severe obstruction or restrictive ventilation dysfunction, PaO2 is reduced, even at rest. There was also a significant decrease in hypoxemia.

1, lung function test

There was no significant correlation between X-ray findings and pulmonary dysfunction in silicosis patients. There was no significant change in lung function in patients with early silicosis without comorbidities. Even when severe lesions appeared on X-ray films, the lung function of patients was not obvious.

(1) Changes in lung function in silicosis patients were marked by changes in lung volume, mostly with restricted ventilatory dysfunction and decreased lung capacity (VC).

(2) The level of forced vital capacity (FVC) in silicosis patients is reduced.

(3) The total lung volume (TLC) of patients with silicosis decreased.

(4) The residual volume (RV) of silicosis patients is reduced.

(5) The degree of reduction in forced expiratory volume (FEV1) of 1 s is parallel to FVC.

(6) FEV1/FVC (%) can be in the normal range, severe smokers and patients with emphysema can have obstructive ventilatory dysfunction or mixed ventilatory dysfunction.

Silicosis due to extensive fibrosis of alveolar and interstitial, capillary occlusion, decreased blood flow, emphysema formation, uneven gas distribution, reduced diffuse area, resulting in diffuse function is often reduced, especially in the formation of agglomerates, blood pH More no abnormalities.

2, X-ray performance

Chest X-ray is the main basis for the diagnosis of silicosis, mainly as nodular shadows, reticular shadows and/or large fusion lesions, followed by hilar changes, lung texture changes and pleural changes.

(1) Typical nodular shadow: The earliest manifestation of silicosis on X-ray films is the appearance of round or round-like shadows, often called nodules, nodules can be scattered, or several clusters of nodules can form overlapping images. The size is similar, the shape is the same, the density is relatively close, the diameter is generally 1~3 mm, and it is mostly distributed in the lower and middle fields of the two lungs, which is more on the right side, and can also be seen first in the two upper lung fields.

The amount of dust in contact with dust and the content of free silica in dust are related to the performance of silicosis nodules. The concentration of dust often forms a high-density typical sacral nodular round or round-like shadow. Once it progresses rapidly, it appears as nodular shadow. Increase, the density increases, the adjacent nodules gather into clusters, close together and develop into a clump-like shadow. The free silica content in the dust is medium, the nodule shadow is relatively small and dense, and finally a large shadow can be formed. But the speed is not as fast as the former.

(2) Late sputum nodules: the lesions merge into a mass-like large shadow with clear edges, with shadows attached to the hilar or pleura, emphysema or pulmonary vesicles around the mass, mainly due to sacral nodules Due to fibrosis, the initial nodules accumulate locally in the lungs, gradually becoming a mass, with a deeper density in the middle and a lighter edge. As the lesion progresses, the density gradually becomes uniform, the contour becomes clearer, and the density increases with a large block shadow. The agglomerates may be single or multiple, more common in the field on both sides of the lungs, often in the shape of a figure-eight or wing or sausage, and the mass may also be asymmetrical or only appear in a certain leaf.

(3) The contraction of the mass causes the tracheal mediastinum to shift, deform, twist, the heart is pulled and displaced, and the hilar is moved upwards, causing the thickened lung pattern to be weeping willow shape. There is a line between the shadow of the mass and the lung door. The shadows are connected, the pleura is a shadow of the pleural contraction due to adhesion shrinkage, and the large mass can form a cavity due to necrosis of ischemia. The simple silicosis of the lungs is less, and there is often a cavity-like necrosis of tuberculosis.

(4) hilar lymphadenopathy, manifested as increased hilar shadow, increased density, blurred edges, characteristic lymph node calcification, a thin and dense "egg-like" ring at the edge of the lymph node Calcification shadows, some can appear in piles, the array of lymph nodes can be fused into a "mulberry-like", which is a characteristic image of silicosis. The degree of calcification is not related to the severity of silicosis or the presence or absence of tuberculosis, even in the absence of obvious silicosis or late silicosis. Existence exists, although not a feature unique to silicosis, but the eggshell-like calcification of lymph nodes often suggests a history of silicosis or free silica contact.

(5) Pulmonary interstitial fibrosis type, where the content of free silica in dust is low, nodular shadows are rare, showing irregular dense line shadows. When such shadows increase, the lung field is unclear or " Frosted glass."

(6) Pleural hypertrophy and adhesion, rib space narrowing, rib angle disappearance and mediastinal pericardial adhesion are also seen on the chest.

3, chest CT recognition of small circular shadows and fused shadows than ordinary chest X-ray films, high-resolution CT (HRCT) can improve the diagnosis by 10%.

Silicosis diagnosis

First, the diagnosis should be based on:

1. History of dust exposure, including free silica content in raw materials and finished products, dust concentration in production environment, dust particle size, production operation methods and protective measures (including personal protection);

2. The patient's detailed occupational history and past health conditions;

3, clinical symptoms, signs and X-ray examination;

4. The past and current incidence of workers of the same type of work.

Second, X-ray examination: At present, the diagnosis of silicosis, in addition to the above basis, mainly based on X-ray chest X-ray performance, China published in December 1986 "Pneumoconiosis diagnostic criteria and treatment principles", which diagnostic criteria for pneumoconiosis X-ray, applicable to the country The legal standards for various pneumoconiosis are as follows:

1, no pneumoconiosis (code 0)

(1) 0 X-ray performance of no pneumoconiosis.

(2) 0+X line performance is not enough to diagnose as "I".

2. Phase I pneumoconiosis (code I)

(1) I has a small circular shadow with a density of 1 level, and the distribution range is at least one in each of the two lung regions, each having a diameter of not less than 2 cm; or an irregular small shadow with a density of 1 level. The distribution range is not less than two lung regions.

(2) The small shadow of I+ is obviously increased, but one of the concentration and distribution ranges is not enough to be defined as "II".

3. Phase II pneumoconiosis (code II)

(1) II has a circular or irregular small shadow with a density of 2, and the distribution range is more than four lung regions; or there is a small shadow with a density of 3, and the distribution ranges up to four lung regions.

(2) II+ has a small shadow with a density of 3, which is distributed over four lung regions; or a large shadow is not enough for "III".

4. Phase III pneumoconiosis (code III)

III has a large shadow, its long diameter is not less than 2cm, and the width is not less than 1cm.

III+ The sum of the area of a single large shadow or the sum of a plurality of large shadow areas exceeds the area of the right upper lung area.

When using the above criteria, the following concepts should be used:

(1) Division of lung region: The vertical distance from the tip of the lung to the dome is divided into three. The horizontal field of the aliquot is used to divide each lung field into upper, middle and lower regions.

(2) Small shadow: refers to the shadow with a diameter or width of no more than 1cm, which can be divided into two types:

Class 1 round (R), the shape is round or nearly circular, and its edges are neat or irregular;

2 Irregular shape (IR) refers to a group of dense shadows of different thickness, length and shape. They can be disconnected from each other, or they can be intertwined in a disorderly manner. They are mesh-like, sometimes honeycomb-shaped, and both types of small shadows are It can be called p (diameter about 1, 5 mm or less), q (diameter about 1, 5 to 3 mm), r (diameter 3 to 10 mm) according to its size or thickness, and irregular shape is called s (width is about 1). , 5mm or less), t (width is about 1, 5 to 3mm), u (width is about 3 to 10mm).

(3) Small shadow density: refers to the number of small shadows within a certain range, which can be divided into 3 levels:

Round small shadow density:

Level 1: Affirmative, a certain amount of round and small shadows, the lung texture is clearly visible (if p, that is, about 10 in the range of 2cm in diameter).

Level 2: A large number of round and small shadows, the lung texture is generally identifiable.

Level 3: A large number of round and small shadows, some or all of the lung texture disappears.

Irregular small shadow density:

Level 1: A considerable amount of irregularly shaped small shadows, the lung texture is generally identifiable.

Level 2: A large number of irregularly shaped small shadows, the lung texture usually partially disappears.

Level 3: A large number of irregular small shadows, the lung texture usually disappears.

The intensity and range determination method should comprehensively determine the intensive conditions of all small shadows appearing in each lung area:

1 to determine the lung area requires small shadows to account for two-thirds of the area;

2 The distribution range is the number of lung regions with small shadows;

3 The majority of the lung area is the main criterion for determining the density;

4 The main criteria for the determination of the higher-level density of not less than two lung regions.

(4) Large shadow: refers to the shadow with a longest diameter of 1cm or more. A large shadow that is not defined as "III" means:

1 small shadow gathers, and has not formed a uniform and dense block shadow;

2 shadows did not reach 2cm × 1cm;

3 "Spot strips" or "white areas" appear.

(5) pleural changes (including thickening, adhesions, calcification), pneumoconiosis or other diseases (such as rheumatoid pneumoconiosis), there are corresponding code records.

(6) Regarding the dynamic observation of each period (+) in favor of the disease, 0+, I+, II+, III+ are added in each period, which is not an independent stage.

For silicosis, when exposed to dust with high strontium content and high concentration, it is often dominated by round and round-like shadows. It first appeared in the inner middle zone of the lower lungs and gradually expanded upwards; In the case of two upper lungs, in the case of low sputum content or inhalation of mixed dust, mostly with circular shadows (so-called reticular shadows), the large shadow of silicosis is increased, dense, and finally merged. In the field on both lungs, the outline is clear, the two lungs are symmetrically "winged" or figure-eight, and the fusion block contracts inward and upward, causing the hilar to be pulled and displaced, and the hilar shadows are often enlarged, dense, and sometimes lymph nodes." Eggshell-like calcification is caused by calcium deposition under the lymphatic capsule, and the lung texture is increased and thickened.

Third, laboratory tests: general examination of silicosis has no special significance, serum protein hexose, hexose, mucin, immunoglobulin, ceruloplasmin and urinary hydroxyproline often increase, but mostly non-specific The normal range of fluctuations is large, and its clinical value is not large.

Fourth, lung function determination: due to lung tissue compensatory function is very strong, early lung function damage is not obvious, with increased lung fiber tissue, decreased elasticity, decreased lung capacity, with the progress of the disease, forced expiratory volume and maximum ventilation in one second Also reduced, the amount of residual gas and its proportion of total lung volume increased, the more severe emphysema, the more obvious these changes, and caused diffuse dysfunction, arterial partial pressure of oxygen at rest can be reduced to varying degrees, lung function is measured Diagnostic significance is not significant, but can be used as the basis for the identification of the ability of silicosis patients.

Differential diagnosis

The diseases that need to be differentiated from silicosis nodules are as follows: acute miliary tuberculosis, pulmonary hemosiderosis, bronchioloalveolar carcinoma, sarcoidosis, alveolar microlithiasis and connective tissue disease.

The silotic lesions of silicosis need to be differentiated from tuberculosis and lung cancer.

1, acute miliary tuberculosis

No occupational exposure history, more common in children, is part of acute hematogenous disseminated pulmonary tuberculosis, acute onset, severe symptoms of poisoning, sometimes associated with tuberculous meningitis and other areas of tuberculosis, X-ray shows chest lung field Uniform distribution, uniform density and size, clear miliary shadow on the edge, anti-tuberculosis treatment effect is better, while silicosis clinical manifestations have no systemic poisoning symptoms, and small nodules shadow on the chest radiograph showing higher density, and occupational exposure history.

2, hemosiderosis

More common in patients with rheumatic heart disease mitral stenosis, history of left heart failure, no occupational history, characterized by repeated episodes of hemoptysis, shortness of breath and unexplained ischemic anemia, with clubbing (toe), splenomegaly, etc. Signs, chest radiographs of varying sizes, uneven distribution, a certain number of fine nodular shadows, high density, with a small number of cord-like shadows, extensive pulmonary interstitial fibrosis in the late stage, sputum and bronchoalveolar lavage fluid Macrophages that phagocytose hemosiderin can be found, often with signs of heart disease.

3, sarcoidosis

For unknown reasons, non-caseous epithelial granulomatous diseases can invade many organs of the body, but most occur in the lungs and intrathoracic lymph nodes. There are often no obvious symptoms or signs in the early stage. Stage II sarcoidosis has hilar lymphadenopathy. Large, accompanied by lung infiltration, lung lesions are widely distributed symmetrically on both sides, nodular, punctate or flocculent shadow, stage III sarcoidosis showed fibrotic changes in the lungs, and hilar lymph nodes disappeared The fibrotic shadow is often mixed with the shadow of granuloma. The lesions may be lung collapse, the diaphragm is elevated, the hilar is lifted, etc. The diagnosis of sarcoidosis is mainly based on chest X-ray, thoracic CT changes, histological biopsy and Kvein. The test is positive, the patient may be accompanied by other organ lesions, the serum angiotensin-converting enzyme activity is increased, and the tuberculin skin test negative or weak positive can be used as a reference index.

4, alveolar microlithiasis

There is often a family history, no history of dust exposure, X-ray chest radiographs are covered with fine sand-like shadows, the size is about 1mm, the edges are clear, the lungs are more common inside, the lungs are not big, and the lung texture has no obvious changes. The course of the disease is progressing slowly.

5, bronchioloalveolar carcinoma

Often cough is more white foam, sometimes hemoptysis, and cancer cells are found in the sputum.

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