Massive melanoptysis: a serious unrecognized complication of coal worker's pneumoconiosis.

Black sputum is produced when cavitation of progressive massive fibrosis occurs due to mycobacterial and anaerobic bacterial infections (67%) or ischaemic necrosis. The blackish or greyish sputum suggests cavitation of conglomerated masses; the acinar shadows in gravity dependent areas together with cavitary pneumoconiosis, make us suspect an insufficiency of bronchial clearing. Bronchoscopy confirms the diagnosis by showing the airway blocked by dark material. During melanoptysis the patient suffers respiratory failure which can be fatal. Close vigilance of the arterial blood gases is essential. Measures must be taken to maintain clear airways. Melanoptysis should be listed with the other complications of coal worker's pneumoconiosis.