Focal emphysema extends into progressive centrilobular emphysema. Less commonly a variant of panacinar emphysema develops.Continued exposure to coal dust following the development of simple CWP may progress to complicated CWP with progressive massive fibrosis (PMF), wherein large masses of dense fibrosis develop, usually in the upper lung zones, measuring greater than 1 cm in diameter, with accompanying decreased lung function. These cases generally require a number of years to develop. Grossly, the lung itself appears blackened. Pathologically, these consist of fibrosis with haphazardly-arranged collagen and many pigment-laden macrophages and abundant free pigment. Radiographically, CWP can appear strikingly similar to silicosis. In simple CWP, small rounded nodules (see ILO Classification) predominate, tending to first appear in the upper lung zones. The nodules may coalesce and form large opacities (>1 cm), characterizing complicated CWP, or PMF. Diagnosis
There are three basic criteria for the diagnosis of CWP:

Chest radiography consistent with CWP
An exposure history to coal dust (typically underground coal mining) of sufficient amount and latency
Exclusion of alternative diagnoses (mimics of CWP)Symptoms and pulmonary function testing relate to the degree of respiratory impairment but are not part of the diagnostic criteria. As noted above, the chest X-ray appearance for CWP can be virtually indistinguishable from silicosis. Chest CT, particularly high-resolution scanning (HRCT), are more sensitive than plain X-ray for detecting the small round opacities. Treatment
There is no cure or discovered treatments for pneumoconiosis. Some patients are given oxygen to help with their breathing and are advised to stop smoking to prevent further decline in lung function.
Perinephritis is an infection of the surroundings of the kidney either right or left. It can be the result of extravasated infiltration of the bacteria out of the renal pelvis (pyelonephritis) or a result of another kidney infection. The consequences include the infection of the neighbouring organs (for example transverse colon) or retroperitoneum, and/or hypertension. Perirenal abscess also may occur. == References ==