Chalicosis
Synonyms and keywords: Flint disease

# Overview
Chalicosis (Greek, , gravel), also called Flint disease, is a disorder of the lungs or bronchioles (chiefly among stonecutters), due to the inhalation of fine particles of stones;  it is a form of pneumoconiosis.

# Historical Perspective
- The term chalicosis was first introduced by Merkel in 1870, for pneumoconiosis cases caused due to fine gravel or stone.
- Chalicosis is seen mostly in stonecutters.

# Pathophysiology
The ciliated epithelium in the lungs, along with mucus secretions and phagocytes protect the airways from dust. When there is exposure to excessive dust, the epithelium is unable to arrest all the pigment, resulting in it's leakage into subpleaural and interbronchial tissues; and interspaces of alveoli. This results in an inflammatory response and release of tumor necrosis factors, interleukin-1, leukotriene B4 and other cytokines resulting in activation of fibroblasts to proliferate and produce collagen around the dust particle; which causes fibrosis and nodular lesions in the lungs.

## Associated Conditions
- Hepatosplenic involvement is not uncommon with chalicosis.

# Causes
- Inhalation of fine particles of stones.

# Differentiating type page name here from other Diseases
- Should be differentiated from other diseases causing pneumoconiosis and those with similar presentation including: cough, dyspnea, pulmonary nodules and fibrosis on chest x-ray
- Silicosis
- asbestosis
- tuberculosis
- aspergillosis
- pulmonary malignancy.

# Risk Factors
- Occupations with excessive exposure to stone dust like excavations in mines, mining of nonferrous metal ores, tunnels, quarries, underground galleries, dry cutting, grinding, sieving and manipulation of minerals and rock, foundry work, milling work, sandblasting and grinding, pottery industry.

# Natural History
Chalicosis is a slowly progressive disease where it can take upto 10 years for the manifestations to occur.

# Diagnosis
- Detailed occupational history should be obtained, including time of exposure to stone dust and measurement of respirable dust.
- Chest X-ray findings are similar to those of pneumoconiosis may include small rounded opacities, small irregular opacities, profusion of opacities, large opacities, zonal distribution of opacities (upper, middle, and/or lower), and pleural thickening (diffuse or circumscribed).
- Pulmonary function test: Decreased TLC, FVC, and DLCO , Normal FEV1 / FVC ratio

## Symptoms
Dyspnea, dyspnea on exertion, chronic, non-productive cough may be present.

## Physical Examination

### Lungs:
- Crackles/rales and inspiratory wheezes maybe present

### Other:
- Cyanosis
- Clubbing

## Laboratory Findings

### Chest X Ray
Chest X-ray findings are similar to those of pneumoconiosis may include small rounded opacities, small irregular opacities, profusion of opacities, large opacities, zonal distribution of opacities (upper, middle, and/or lower), and pleural thickening (diffuse or circumscribed).

# Treatment

## Pharmacotherapy
- Treatment of chalicosis consists of managing associated respiratory symptoms and comorbidities and complications (e.g. COPD or tuberculosis). There is no targeted therapy for chalicosis
- Management goals include avoidance of exposure to stone dust, optimization of respiratory function, and preventive care.

### Acute Pharmacotherapies
- Systemic steroids may be used for acute management of symptoms.

### Chronic Pharmacotherapies
- Systemic steroids are not recommended for chronic management.
- Supplemental oxygen is administered to prevent complications of chronic hypoxemia
- Bronchodilators if airflow limitation is present on spirometry.
- Smoking cessation