Anthracosis of the lungs is black discoloration of bronchial mucosa that can occlude bronchial lumen and is associated with bronchial anthracofibrosis (BAF).
This disease usually presents with a chronic course of dyspnea and or cough
- in an elderly non-smoker woman or man.
- In addition, concomitant exposure to dust and wood smoke is the most postulated etiology for anthracosis.
- Coal minere are at huge risk of amthracosis.
Appearance:
Anthracosis (anthrac- meaning coal, carbon + -osis meaning condition) is defined in Bioline as, “the asymptomatic, milder type of pneumoconiosis as caused by the accumulation of carbon in the lungs due to repeated exposure to air pollution or inhalation of smoke or coal dust particles”.
Anthracosis may be seen as a superficial black discoloration (simple anthracosis) or scattered foci of black spots, which retract mucosa inward due to the effect of adjacent anthracotic lymphadenopathy.
History:
Anthracosis is an ancient disease discovered in mummies. The early scientific reports of this disease were mainly from Western countries and the term “anthracosis” was coined by Pearson in 1813 . Pearson and others believed that anthracosis was a complication of coal worker pneumoconiosis . However, the interest of Western countries in this disease declined as the frequency of anthracosis declined in their countries. The second wave of anthracosis in the literature started in Asia, as it is still a problem in this continent. Most of these studies showed that pneumoconiosis and exposure to coal were not the most frequent risk factors and thus researchers excluded pneumoconiosis patients from the category of anthracosis. Chung et al.introduced BAF as a unique clinical syndrome. It is the severe form of disease, which distorts and narrows the bronchial lumen. Later, some new terms were introduced such as anthracostenosis or anthracotic bronchitis used to describe extensive deposition of carbon in the main bronchial walls; which in the majority of cases is accompanied by severe submucosal edema, bronchial stenosis, protruded mucosal folds and lung collapse .
Diagnosis:
Pulmonary function tests usually show an obstructive pattern with no response to bronchodilators and normal DLCO, but some cases with restrictive pattern have also been seen. Computed tomography (CT) may show more specific findings such as lymph node or bronchial calcification and mass lesions. Final diagnosis can be made by bronchoscopy when obtaining samples for tuberculosis (TB), which is the most common disease associated with BAF. Endobronchial ultrasound shows a hypoechoic scattered nodular pattern in adjacent lymph nodes, which is unique to anthracosis.
Treatment:
Treatment is very similar to that of chronic obstructive pulmonary disease (COPD) with a chronic course and low mortality. This review discusses this disease as a separate entity; hence, anthracosis should be added to the list of obstructive lung diseases and benign mass lesions and differentiated from biomass induced COPD.
