Anthracosis and anthracofibrosis in an Australian population.

Abstract

Introduction: Anthracosis, caused by airway carbon deposition, can lead to bronchial stenosis (anthracofibrosis). Though rare in Western populations, international migration necessitates clinician awareness. This study examined its prevalence, radiology, clinical associations in 2 metropolitan hospitals. Method(s): Bronchoscopy/endobronchial ultrasound (EBUS) reports and related casefiles (Oct 2022-Oct 2024) were reviewed for anthracosis. Result(s): Among 1,514 procedures, anthracosis was found in 108, with 28.7% featuring anthracofibrosis. All anthracofibrotic cases had CT abnormalities:bronchial narrowing (16.1%), parenchymal abnormalities (96.8%), and lymphadenopathy (82.9%). Cases were evaluated for tuberculosis (TB) (41.9%), malignancy/lymphadenopathy (16.1%), or both (32.3%). Predictors of anthracofibrosis included age (OR 1.04(1.01-1.1)), female sex (OR 3.8(1.3-10.9)) and Afghan origin (OR 4.2(1.7-10)). Active TB was confirmed in 16.1%, with no malignancies. PET scans were done in 25.8%, 87.5% showed parenchymal or nodal avidity. 16.1% had multiple bronchoscopies, 71.4% for suspected TB - all negative. Conclusion(s): Anthracosis and anthracofibrosis are not uncommon in bronchoscopy, particularly among Afghan female immigrants. Their radiological mimicry of infection and malignancy often leads to unnecessary procedures. Greater clinician awareness and cost-effective diagnostics are needed to differentiate anthracofibrosis from other conditions.