Imaging of Occupational Lung Disease

Our plain-English summary of Imaging of Occupational Lung Disease, by J. Champlin, R. Edwards, S. Pipavath (Radiologic Clinics of North America, 2016).

The study

• Authors: J. Champlin, R. Edwards, S. Pipavath
• Journal: Radiologic Clinics of North America
• Published: 2016;54(6):1077-1096
• Type of article: Review
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Occupational lung diseases span a variety of pulmonary disorders caused by inhalation of dusts or chemical antigens in a vocational setting. Included in these are the classic mineral pneumoconioses of silicosis, coal worker's pneumoconiosis, and asbestos-related diseases as well as many immune-mediated and airway-centric diseases, and new and emerging disorders. Although some of these have characteristic imaging appearances, a multidisciplinary approach with focus on occupational exposure history is essential to proper diagnosis.

Copyright © 2016 Elsevier Inc. All rights reserved.

In plain English

This article was a narrative review describing how occupational lung diseases look on chest X-rays and high-resolution CT (HRCT) scans. It covered silicosis, coal mine dust diseases, asbestos-related disease, other dust diseases, beryllium and hard metal disease, hypersensitivity pneumonitis, occupational asthma and newer conditions. It reported no new patient data. Drawing on earlier studies, the review stated that pleural plaques develop in up to 80% of asbestos-exposed workers and are not precursors of mesothelioma. It said diffuse pleural thickening occurs in 22% to 25% of those exposed and benign pleural effusions in 3% to 7%. It described amphibole fibers (amosite, crocidolite, tremolite) as more fibrogenic and carcinogenic than chrysotile. It noted that no CT finding is specific for asbestosis, with exposure history and pleural plaques the main clues. It also listed CT features suggesting mesothelioma. The authors concluded that HRCT is more sensitive and specific than X-ray, but that many findings are nonspecific and diagnosis needs a multidisciplinary approach focused on occupational exposure history.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: narrative review of imaging findings in occupational lung diseases, based on published literature
• Who was studied: no patients or workers were studied; the article reviewed published literature on occupational lung diseases
• Exposure: occupational dusts and chemical antigens, including crystalline silica, coal mine dust, asbestos, iron, talc, beryllium, hard metals (cobalt and tungsten carbide) and others; for asbestos, chrysotile (serpentine) and the amphiboles amosite, crocidolite and tremolite (printed 'tremolitie')
• Main results:
  • Citing earlier work, the review stated pleural plaques develop in up to 80% of asbestos-exposed workers, generally 20 to 30 years after initial exposure
  • The review stated that pleural plaques do not undergo malignant degeneration and are not precursor lesions of mesothelioma
  • Citing earlier work, the review stated diffuse pleural thickening occurs in 22% to 25% of those exposed to asbestos
  • Citing earlier work, the review stated benign asbestos pleural effusions are seen in 3% to 7% of exposed patients, a figure likely underestimated because effusions are often subclinical
  • The review stated none of the HRCT findings are specific for asbestosis; exposure history and asbestos-related pleural plaques help suggest it
  • HRCT findings described as suggesting pleural malignancy such as mesothelioma included nodular and circumferential pleural thickening greater than 10 mm, mediastinal or fissural involvement, or invasion of chest wall, diaphragm or mediastinum
  • The review stated HRCT is more sensitive than radiography for detecting pleural plaques
• The authors' conclusion: The authors concluded that radiography remains the first imaging test but HRCT has higher sensitivity and specificity, that low-dose HRCT may become a viable screening option, and that because many findings are nonspecific, a multidisciplinary approach focused on occupational exposure history is essential for diagnosis

Topics

Medical terms in this study, explained in our Lexicon: Occupational Lung Disease, Silicosis, Pneumoconiosis, Multidisciplinary Team, Occupational Exposure History.

Related studies

• Bronchoalveolar lavage in occupational lung diseases — C.R. Cordeiro, J.C. Jones, et al. (2007)
• Imaging of occupational lung disease — K.I. Kim, C.W. Kim, et al. (2001)
• Current evidence base of FDG-PET/CT imaging in the clinical management of malignant pleural mesothelioma: emerging significance of image segmentation and global disease assessment — S. Basu, B. Saboury, et al. (2011)
• Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists — R.A. Vicens, M. Patnana, et al. (2015)
• Comparison of chest digital tomosynthesis and chest radiography for detection of asbestos-related pleuropulmonary disease — G. Lee, Y.J. Jeong, et al. (2013)
• Commentary on: Comparison of chest digital tomosynthesis and chest radiography for detection of asbestos-related pleuropulmonary disease — I. Vlahos (2013)

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