This 53 year old man had attended the Outpatient's Department for several years suffering from dyspnoea. Eight days before his final hospital admission he experienced sudden onset of severe shortness of breath which became extreme in the next few minutes. On admission to hospital there were signs of a left pneumothorax. Although pleurocentesis produced immediate relief, there was gradual deterioration and death. No occupational history is available, but there can be no doubt that this man must have been exposed to excessive amounts of coal dust or carbon, most likely as a worker in the coal industry.
The lung has been sliced vertically and mounted to display the cut surface of the upper lobe and part of the lower lobe. The lung parenchyma is black in colour due to the accumulation of carbon pigment. A ragged cavity 2 x 3 cm in diameter lined by friable black tissue is present in the upper lobe. The hilar lymph nodes are heavily pigmented. The pleura is thickened and there are fibrous adhesions on the pleural surface. This is an extreme example of pulmonary anthracosis.
The cavity may be the site of an old pyogenic or tuberculous abscess. However, tuberculosis is not a recognised complication of anthracosis (c.f. silicosis). The term pneumoconiosis refers to a number of lung conditions caused by the inhalation of dusts, either organic or inorganic. The dust diseases are often of industrial origin, and include diseases such as asbestosis, silicosis and coal-workers' pneumoconiosis. These diseases may result in severe pulmonary fibrosis. The organic dusts (e.g. mouldy hay or sugar-cane dust) are often contaminated by fungal antigens, and by means of antigen - antibody reactions, may result in episodes of extrinsic allergic alveolitis. Repeated severe episodes may lead to diffuse interstitial pulmonary fibrosis.