JK Amorosa. State of the Art Imaging of Occupational Lung Disease Cox, C et al Radiology 2014, 270:...
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Transcript of JK Amorosa. State of the Art Imaging of Occupational Lung Disease Cox, C et al Radiology 2014, 270:...
JK Amorosa
State of the Art Imaging of Occupational Lung Disease Cox, C et al Radiology 2014, 270: 681-696
Team approach: occupational med physician, pulmonologist, radiologist
Exposure hx, PE, Lab, Pulmonary function, imaging, bronchoscopy/Sx
Asbestos
fibrous mineral: amphiboles/ banned since 1970s chrysotile fibers still used in:
construction materials: roofing, siding shingles, pipe and boiler insulation, floor/ ceiling tiles
carcinogen years following asbestos exposure
Asbestos
undisturbed asbestos-containing materials: no health risk
damaged or disturbed, or deteriorate over time and release asbestos fibers into building air: health risk
WHO
200,000 people die each year from cancers related to their workplaces, mainly from inhaling asbestos fibers and second-hand tobacco smoke.
125 million people worldwide are exposed to asbestos at work and every 10th lung cancer death is related to occupational hazards, which amount to at least 90,000 deaths each year.
Occupational Lung DiseasesOccupational Lung Diseases
Occupations at Risk
Asbestos Exposure
Occupations Miners Millers Cement workers Construction Demolition Railroad workers Pipe fitters Shipyard workers Fertilizer manufacturers Brake repair Pharmaceuticals Diesel exhaust Fire fighters Aircraft workers
Plastics Steel workers Explosives Ceramics Fuels Sanders Welders Polishers Paint Boiler makers Bleach Textiles Chrome plating Floor tilers Paper industry
Pigments Oil/ Petroleum Refinery workers Chemistry Electronics Dye Bricklayers Farmers US Navy Sewer cleaners Atomic
energy Roofers Rubber
Asbestos: mineral
Composition: Silicon Oxygen Hydrogen Calcium Sodium Metals:
magnesium, iron
Characteristics: Strength Flexibility Low electrical
conductivity Resistant to heat
and chemicals Greek origin
means: inextinguishable, or indestructible
Occupational Lung Diseases Occupational lung diseases are caused
by inhaled particles,mists, vapors or gases while at work.
Asbestos Exposure
in 3000 commercial products
1940 - 1979 US 27 million people occupational exposure to asbestos
7% were engaged in primary mining, milling, and manufacturing of asbestos products
P N E U M O C O N I O S I S
LUNG DUST
Asbestos exposure
Pleural manifestations
Pulmonary manifestations
ASBESTOS EXPOSURE-Pleural
1.1. Pleural plaquesPleural plaques
2.2. Pleural effusion, benignPleural effusion, benign
3.3. MesotheliomaMesothelioma
4.4. Rounded atelectasis – always Rounded atelectasis – always associated with chronic pleural associated with chronic pleural processprocess
Asbestos Related Lung Disease: Asbestosis
Asbestosis is the term reserved for pulmonary fibrosis caused by the inhalation of asbestos fibers. Subpleural lower lobes areas - mostly
Malignant masses: lung ca
Benign mass: rounded atelectasis, pleural thickening, mass contains low density centrally, has comet tail containing crowded vessels and bronchi
Dx: Asbestos related pleural plaques, marker of exposure, usually asymptomatic
Findings: Calcified
pleural plaques
Findings: calcified pleural plaques
Judith K Amorosa
Location of pleural plaque
1991 1998
Pleural effusion
55 yo man with R chest pain
59 yo man with dull R chest pain
19971995
Mesothelioma
Pleural Based Masses, Ddx: mesothelioma or metastatic lung ca
50+ male with shoulder pain
Dx: mesothelioma
Suspect mesothelioma
Chest X-ray CT PET MR chest wall and diaphragmatic
involvement
Localized malignant mesothelioma (stage I)
Unilateral parietal or visceral pleura and pericardium
Advanced malignant mesothelioma (stage II,stage III, and stage IV) stage II, cancer in ipsilateral pleura, pericardium In stage III, cancer has spread to any of the following
areas: The chest wall. The mediastinum. The heart. Beyond the diaphragm. The peritoneum.
Cancer may have also spread to lymph nodes on the other side of the chest or outside the chest.
In stage IV, cancer has spread to distant organs or tissues.
49 yo woman with a pelvic mass
Metastatic ovarian ca
Rounded Atelectasis
Broncho-vascular bundle, “comet sign”
Rounded atelectasis
Asbestos related pleural plaques, rounded atelectasis, fibrosis: asbestosis
Asbestos Related Lung Disease: Asbestosis
Asbestosis is the term reserved for pulmonary fibrosis caused by the inhalation of asbestos fibers. Subpleural lower lobes areas - mostly
Malignant masses: lung ca
Benign mass: rounded atelectasis, pleural thickening, mass contains low density centrally, has comet tail containing crowded vessels and bronchi
Dx: Asbestosis and Pleural plaques
Pattern: Rounded atelectasis
Asbestos exposure
Atypical
Silicosis
83 m
Emphysema, plaques, asbestosis,Lung ca
Asbestosis; Ddx:IPF, scleroderma
Development of lung disease is dependent on Intensity of
exposure Duration of
exposure Physiologic and
biologic susceptibility of host
HRCT: Septal and centrilobular thickening, long scars, parenchymal bands, subpleural lines, honeycombing
Radiograph: lower and mid lung zone reticulo-nodular process, causing “shaggy” heart border, honeycomb
AsbestosisAsbestosis
Judith K Amorosa
Dx: Asbestosis
Findings: Calc
plaques Pulmona
ry fibrosis
Judith K Amorosa
Lung Cancer
NIOSH: National Institute of
Occupational Safety and Health
Silicosis
Silicosis
Small well-defined nodules of 2 to 5mm in diameter in both lungs
Upper lobe predominanceNodules may be calcifiedCentrilobular and subpleural distributionSometimes random distributionIrregular conglomerate masses, known as progressive massive fibrosisOften hilar and mediastinal lymphnodes.
Miliary pattern: TB, histo, coccydio, mets, silicosis
Judith K Amorosa
Alveolitis – acute silicosis
Dx: Complicated Silicosis, CWPPMF or conglomerate massesFindings:
Upper lobe symmetrical masses
Upper lung nodules
Complicated silicosis: PMF
Silicosis, complicated (PMF, Conglomerate mass), Ddx: Sarcoid, TB
Complicated silicosis in a 58-year-old man.
Kim K et al. Radiographics 2001;21:1371-1391
©2001 by Radiological Society of North America
Pattern
Silicosis- upper lung nodules
Asbestosis -lower lung linear opacities
Pattern: Consolidation
Acute silicosis Hypersensitivity pn Ardystil syndrome (Spain-
printing fabric by spraying with pulverized dyes)
Flockworkers lung disease (Rhode Island car upholstery)
radiologyassistant
Acute exposure-inhalation to aerosolized (airborne) fibers, fumes, mists, dust – toxins, chemicals
Pattern: GG
Acute Silicosis Hypersensitivity pn Hard metal Flockworkers lung Indium-tin oxide
Rarely Chronic beryllium Asbestosis Siderosis Accelerated
silicosis
HP glassblower
60 m GG pattern
Pattern: crazy paving
Acute silicosis Indium-tin oxide (ITO)
Eosinophilic Pneumonia
Pattern: centrilobular nodules Acute silicosis Hypersensitivity pn Siderosis Flock workers lung Ardyll syndrome ITO Byssinosis Accelerated
silicosis
Rarely: Chronic silicosis CWP(Coal
Workers’s P) Aluminosis Hard metal lung
radiologyassistant
Hard Metal Lung Disease(HMLD), also called Giant cell Interstitial Pneumonia (GIP)
Characterized by “cannibalistic” multinucleated giant cells in airspaces on BAL
Powdered tungsten carbide and cobalt
Called sintered carbides, hard as diamond
Pattern: Perilymphatic/subpleural nodules
Chronic Silicosis CWP Chronic beryllium
dis Talcosis Calcinosis Stannosis
HMLD Aluminosis Accelerated
silicosis Asbestosis
Pattern: Fibrosis (UIP, NSIP patterns)
Asbestosis Hypersensitivity pn
Atypical Chronic silicosis CWP Chronic beryllium HMLD Siderosis Ardystil S Flock workers lung ITO Aluminosis
Pattern: Masses
Complicated silicosis (PMF)
CWP Talcosis
Atypical Siderosis Chronic beryllium
disease
Pleural Plaque
Etiologies of Interstitial Pulmonary fibrosis include
1. Scleroderma2. Idiopathic3. Asbestosis4. Silicosis
Acute Hypersensitivity Pneumonia
83 f
AIP vs HP
In the secondary Pulmonary Lobule the bronchiole is located
1. Along the pulmonary vein
2. Along the interlobular septum
3. Along the pulmonary artery
American Journal of Roentgenology. 2001;177: 501-519. 10.2214/ajr.177.3.1770501
Sequiosis (red wood)
Judith K Amorosa
Mushroom workers’ pneumoconiosis isorgani
c
Secondary pulmonary lobule
supplied by terminal
bronchiole in the center, parallelled by the centrilobular artery Pulmonary veins & lymphatics run in the periphery of
the lobule within the interlobular septa
Hypersensitivity pneumonitis
Respiratory bronchiolitis in smokers
infectious airways diseases (endobronchial spread of tuberculosis or nontuberculous mycobacteria, bronchopneumonia)
Uncommon in bronchioloalveolar carcinoma, pulmonary edema, vasculitis
Organic Pneumoconiosis is1. Asbestosis2. Mushroom worker’s
disease3. Silicosis4. Berylliosis
Asbesto
sis
Mush
room w
orke...
Silic
osis
Berylliosis
0% 0%0%0%
Silicotic nodules
1. Peribronchiolar2. Upper lobes and
perihilar3. Lower lobes4. Coalesce: PMF
Peribro
nchiola...
Upper l
obes an...
Lower lo
bes
Coalesce: P
MF
0% 0%0%0%
Organic Pneumoconiosis is1. Asbestosis2. Mushroom worker’s
disease3. Silicosis4. Berylliosis
Asbesto
sis
Mush
room w
orke...
Silic
osis
Berylliosis
0% 0%0%0%
Subacute HP
Ill defined centrilobular GGO nodules
Relative sparing c air-trapping
Eur Respir Rev June 1, 2010 vol. 19 no. 116 97-108
Organic
Hay Malt Mushroom Barley Cotton (byssinosis) flax
Pneumoconiosis - most common
Asbestosis Berylliosis Byssinosis CWP (Coal Workers Pneumoconiosis) Silicosis
Kun –Kim et al November 2001 RadioGraphics, 21, 1371-1391.
Reactions
Acute Inflammation Edema
Chronic Fibrosis Granuloma
jd.
jd
jd
Jd Ddx: Sarcoidosis, Complex silicosis
Siderosis
Iron ore miners Welders Steel workers
Fibrosis Obstructive airway
disease Lung ca
Byssinosis (brown lung)
Exposure to dust from cotton, hemp and flax
Causes blockage of small airways
?? Endotoxin release from cell walls of Gm-bacteria
Flockworkers lung disease At Microfibres Inc in Rhode Island
two young men developed interstitial lung disease
Plant made carpet-like material for car upholstery. Workers cut long nylon strands into short nylon fibers called flock. The fragments were in the respirable size and were inhaled by the workers
ITO Indium tin oxide
Transparent , colorless, when deposited as a thin film on glass, it acts as an electrical conductor
Used for display technology: LCD, plasma, electroluminescent, touch screen technology
ABR questions about
application, analysis, management