Spectrum of high resolution computed tomography findings in occupational lung disease: experience in a tertiary care institute

Our plain-English summary of Spectrum of high resolution computed tomography findings in occupational lung disease: experience in a tertiary care institute, by S. Bhawna, U.C. Ojha, S. Kumar, et al (Journal of Clinical Imaging Science, 2013).

The study

• Authors: S. Bhawna, U.C. Ojha, S. Kumar, R. Gupta, D. Gothi, R.S. Pal
• Journal: Journal of Clinical Imaging Science
• Published: 2013;3:64
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: To study the spectrum of high resolution computed tomography (HRCT) findings in occupational lung disease in industrial workers and to assess the utility of International classification of HRCT for occupational and environmental respiratory diseases (ICHOERD).

Materials And Methods: Retrospective analysis of radiological data (radiographs and computed tomography chest scans) gathered over a period of 3 years (January 2010- December 2012) of industrial workers in an organised sector who presented with respiratory complaints. The HRCT findings were evaluated using ICHOERD.

Results: There were 5 females and 114 males in the study, with a mean age of 49 years. These workers were exposed to different harmful agents including silica, asbestos, cotton dust, metal dust, iron oxide, organic dust, rubber fumes, plastic fumes, acid fumes, and oil fumes. There were 10 smokers in the study. The radiograph of chest was normal in 53 patients. 46% of these normal patients (21.8% of total) demonstrated positive findings on HRCT. When the radiograph was abnormal, HRCT provided more accurate information and excluded the other diagnosis. The HRCT findings were appropriately described using the ICHOERD. Bronchiectasis was the most common finding (44.5%) with mild central cylindrical bronchiectasis as the most common pattern. Pleural thickening was seen in 41 patients (34.5%). Enlarged hilar or mediastinal lymphnodes were seen in 10 patients (8.4%) with egg-shell calcification in 1 patient exposed to silica. Bronchogenic carcinoma was seen in 1 patient exposed to asbestos.

Conclusions: Occupational lung disease is a common work related condition in industrial workers even in the organized sector. Though chest radiograph is the primary diagnostic tool, HRCT is the undisputed Gold Standard for evaluation of these patients. Despite the disadvantage of radiation exposure, low dose CT may serve as an important tool for screening and surveillance. The ICHOERD is a powerful and reliable tool not only for diagnosis, but also for quantitative and analytical measurement of disease, thereby contributing to assessing the medical epidemiology of lung disease. It should always be used while evaluating HRCT of a patient with occupational lung disease.

In plain English

This retrospective study reviewed chest X-rays and high resolution CT (HRCT) scans of industrial workers seen for medical check-ups at an occupational health institute in New Delhi, India, between January 2010 and December 2012. The scans were described using an international HRCT classification for occupational and environmental respiratory diseases (ICHOERD). Of 150 workers, 31 were excluded for findings suggesting other diseases, leaving 119 (114 men, 5 women; mean age 49). Exposures varied: six workers had asbestos exposure and 13 had silica exposure. The X-ray was normal in 53 workers, and 26 of these showed abnormal findings on HRCT. Across all 119, bronchiectasis was the most common HRCT finding (53 patients, 44.5%), and pleural thickening was seen in 41 (34.5%). Of the six asbestos-exposed workers, one had a normal HRCT, three had pleural plaques, two had honeycombing, and one had bronchogenic carcinoma. No malignant mesothelioma was recorded. The authors concluded that HRCT has become the gold standard for evaluating suspected occupational lung disease. They noted that the study was retrospective and that its subgroups were very small.

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: Retrospective review of chest radiographs and HRCT scans, with HRCT findings described using the ICHOERD classification
• Who was studied: Of 150 industrial workers from the organized sector who attended an occupational and environmental health institute in a tertiary care setting in New Delhi, India, for medical check-ups (January 2010 to December 2012), 31 were excluded. That left 119 patients with a diagnosis of occupational lung disease: 5 women and 114 men, aged 31 to 74 (mean 49), including 10 smokers.
• Exposure: Various hazardous agents, listed in Table 1: metal dust (30), silica (13), oil fumes (3), acid fumes (7), cotton dust (8), plastic fumes (10), organic dust (10), asbestos (6), rubber fumes (9), iron (10), others (13). The asbestos fiber type is not stated.
• Main results:
  • All 119 patients: the chest radiograph was normal in 53, and 26 of these 53 showed positive findings on HRCT
  • All 119 patients: bronchiectasis was the most common HRCT finding, in 53 patients (44.5%)
  • All 119 patients: pleural thickening in 41 patients (34.5%)
  • All 119 patients: enlarged hilar or mediastinal lymph nodes in 10 patients (8.4%)
  • Silica-exposed patients (13): rounded opacities were the most common finding (9 of 13)
  • Asbestos-exposed patients (6): one had a normal HRCT; 3 of 6 had irregular lines (intralobular septal thickening) with ground glass opacity
  • Asbestos-exposed patients: honeycombing in two, pleural plaques in three, pleural calcification in one, round atelectasis in one
  • One asbestos-exposed patient developed bronchogenic carcinoma
  • No malignant mesothelioma was recorded among the 119 patients
  • Patients with progressive massive fibrosis, lung carcinoma, and asbestosis had gradually worsening symptoms, in some cases leading to death (no numbers given)
• The authors' conclusion: The authors concluded that, although the chest radiograph is the first diagnostic tool, HRCT has become the gold standard for evaluating patients with suspected occupational lung disease
• Limitations the authors state:
  • The study was retrospective
  • Each exposure subgroup was very small
  • Lung findings may result from a combination of workplace agents rather than one agent
  • Selecting patients with one predominant exposure led to selection bias
  • Tissue (histopathological) confirmation was not available for every case

Topics

Medical terms in this study, explained in our Lexicon: Occupational Lung Disease, High-Resolution CT (HRCT), Pleural Thickening, Bronchogenic Carcinoma, Chest X-Ray, Epidemiology.

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• Conventional and high resolution computed tomography in the diagnosis of asbestos-related diseases — D.A. Lynch, G. Gamsu, et al. (1989)
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