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A breathless builder

J.J. Lyons, P.J. Sime, D. Ward, T. Watson, J.L. Abraham, R. Evans, M. Budev, K. Costas, W.S. Beckett
Breathe 2007 3: 386-390; DOI: 10.1183/18106838.0304.386
J.J. Lyons
1Division of Pulmonary and Critical Care Medicine, University of Rochester, Rochester, NY, USA
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  • For correspondence: jason_lyons@urmc.rochester.edu
P.J. Sime
1Division of Pulmonary and Critical Care Medicine, University of Rochester, Rochester, NY, USA
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D. Ward
2Dept of Anesthesiology and Biomedical Engineering, University of Rochester, Rochester, NY, USA
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T. Watson
3Division of Thoracic/Foregut Surgery, University of Rochester, Rochester, NY, USA
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J.L. Abraham
4Dept of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
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R. Evans
5Dept of Pulmonary, Cayuga Medical Center, Ithaca, NY, USA
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M. Budev
6Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
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K. Costas
3Division of Thoracic/Foregut Surgery, University of Rochester, Rochester, NY, USA
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W.S. Beckett
1Division of Pulmonary and Critical Care Medicine, University of Rochester, Rochester, NY, USA
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Extract

The patient was a 30-year-old male mason whose work frequently involved cutting and grinding brick and cement with powered tools. He was an active smoker (1–1.5 packs per day). He had worked in building construction since the age of 14 yrs, as a labourer then as a mason and had been a mason for the previous 13 years. He reported frequent exposure to cement and brick dust while removing stone floors with a jackhammer. From 8–2 months prior to presentation, he had been employed repairing exterior brick on three large apartment buildings (figure 1). This required cutting through brick and mortar with a powered, high-speed demolition saw and grinding mortar from between bricks with a powered hand-grinder, a common task known as “tuckpointing” (figure 2), while intermittently using a disposable particle mask. After completing this job, he felt well for ~2 months and then gradually began to develop a nonproductive cough, dyspnoea on exertion and an 11 kg weight loss without fever. Serial pulmonary function testing showed restriction and a marked reduction in diffusing capacity. Chest computed tomography (CT) showed bilateral diffuse infiltrates. A purified protein derivative test was negative. Bronchoalveolar lavage fluid was mucoid, and culture was negative. A transbronchial biopsy was nondiagnostic and the post-bronchoscopy chest film showed a very small right apical pneumothorax. An HIV test was negative.

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A breathless builder
J.J. Lyons, P.J. Sime, D. Ward, T. Watson, J.L. Abraham, R. Evans, M. Budev, K. Costas, W.S. Beckett
Breathe Jun 2007, 3 (4) 386-390; DOI: 10.1183/18106838.0304.386

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A breathless builder
J.J. Lyons, P.J. Sime, D. Ward, T. Watson, J.L. Abraham, R. Evans, M. Budev, K. Costas, W.S. Beckett
Breathe Jun 2007, 3 (4) 386-390; DOI: 10.1183/18106838.0304.386
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