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Introduction: Our article underlines the importance of a good professional anamnesis, knowing all the chemical components with which the patient had been exposed to during her active life as a teacher. Case presentation: A 64-year-old female patient, teacher for 27 years, who had been retired for six years, presented cough with white phlegm and shortness of breath occurring during physical exertion, diffuse thoracic pain, and fatigue. Several lung functional tests were performed, which established the diagnosis of irreversible minor mixed ventilatory dysfunction. In order to establish the etiology of the patient’s symptoms, multiple clinical, laboratory, imaging, and functional investigations were performed including a chest radiograph, pulmonary functional testing, bronchial reversibility testing, a thoracic CT scan, fibrobronchoscopy, alveolar-capillary diffusion capacity measurement, otorhinolaryngology examination, thyroid ultrasound, as well as a cardiological consult. Finally, a positive diagnosis was established: bronchial hyperreactivity syndrome, chalk dust-induced diffuse pulmonary fibrosis. Conclusion: An essential part of clinical practice is a proper anamnesis, including detailed information on the professional history and exposure, as well as the composition of the dust/particles with which the patient had been in contact with.

Introduction: Our article offers a deeper insight into an important occupational disease — coal workers' pneumoconiosis, with all its diagnosis difficulties, treatment steps, and strategies. Case presentation: A 33-year-old male patient, smoker, with 16 years of outside exposure to coal dust, presents shortness of breath and cough, which existed 4 months prior to presentation and progressed in time. The first chest X-ray has raised differential diagnosis difficulties with miliary tuberculosis, despite the patient’s exposure history. All the investigation procedures performed afterwards (clinical examination, fibrobronchoscopy with microlavage and cytological examination, chest computed tomography, and routine laboratory investigations) were not enough to provide a certain and final diagnosis. Exploratory thoracotomy with lung biopsy was needed, and its findings started to sustain the professional disease diagnosis that had already taken shape. To exclude a disease which can evolve hand in hand, but also as a therapeutic application, we decided that a whole lung lavage was needed. Conclusion: Although whole lung lavage could not be accomplished completely, the performed right middle lobe bronchoalveolar lavage had a huge impact, not only on the patient’s symptomatology, but also on the paraclinical results.

Silicosis is one of the oldest occupational diseases, known since the time of Hippocrates, and the diagnosis can be established after a latency time of more than 10 years after exposure cessation. In some cases of chronic silicosis, the disease can progress slowly, evolving over several decades, but it can also evolve into massive pulmonary fibrosis, also known as accelerated silicosis. Furthermore, in extremely rare cases, the disease can present a rapid progression into acute silicosis or silicoproteinosis. The present article gives a deeper view into silicosis and secondary massive progressive pulmonary fibrosis, as well as the difficulties encountered in the management of such patients. We present two different but similar cases that underline the importance of a precise diagnosis, pointing out the long latent period after the exposure to silicon-dioxide, more than 15 years in both cases. This accelerated form of silicosis associated with massive pulmonary fibrosis progressed in 2 years into respiratory failure in both cases.