[Downloaded free from http://www.ijri.org on Wednesday, May 11, 2016, IP: 182.253.162.

198]

CHEST RADIOLOGY MINISYMPOSIA

Spectrum of high-resolution computed
tomography imaging in occupational
lung disease
Bhawna Satija, Sanyal Kumar, Umesh Chandra Ojha2, Dipti Gothi1
Department of Radiodiagnosis, 1Pulmonary Medicine, 2Institute of Occupational Health, Environment and Research, Employee’s
State Insurance Hospital and Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India

Correspondence: Dr. Sanyal Kumar, B-1/57, First Floor, Paschim Vihar, New Delhi - 110 063, India. E-mail: satijabhawna@yahoo.com

Abstract
Damage to the lungs caused by dusts or fumes or noxious substances inhaled by workers in certain specific occupation is known as
occupational lung disease. Recognition of occupational lung disease is especially important not only for the primary worker, but also
because of the implications with regard to primary and secondary disease prevention in the exposed co-workers. Although many
of the disorders can be detected on chest radiography, high-resolution computed tomography (HRCT) is superior in delineating the
lung architecture and depicting pathology. The characteristic radiological features suggest the correct diagnosis in some, whereas
a combination of clinical features, occupational history, and radiological findings is essential in establishing the diagnosis in others.
In the presence of a history of exposure and consistent clinical features, the diagnosis of even an uncommon occupational lung
disease can be suggested by the characteristic described HRCT findings. In this article, we briefly review the HRCT appearance
of a wide spectrum of occupational lung diseases.

Key words: High-resolution computed tomography; occupational lung disease; pneumoconiosis

Introduction occupational lung disease is especially important not only
for the primary worker, but also because of the implications
Occupational lung disease represents the most frequently with regard to primary and secondary disease prevention
diagnosed work-related condition after injuries. These in the exposed co-workers.
comprise of various disorders secondary to the inhalation or
ingestion of dust particles or noxious chemicals, and include The clinical, radiologic and pathologic manifestations
pneumoconiosis, asbestos-related pleural and parenchymal of occupational lung disease may be identical to
disease, chemical pneumonitis, infection, hypersensitivity nonoccupational variants because of the lung’s limited
pneumonitis, and organic dust toxic syndrome. capacity of response to injury. A high degree of suspicion
directing a thorough occupational history to search for
Pneumoconiosis may be clinico-pathologically classified potential exposures is the key to accurate diagnosis.
as fibrotic or non-fibrotic. Recent decades have seen a Diagnosis of an occupational lung disease requires definite
marked increase in concern about the adverse health effects history of exposure to an agent known to cause interstitial
of harmful exposures in the workplace. Recognition of lung disease (ILD), an appropriate latency period, a
consistent clinical presentation, physiologic and radiologic
Access this article online pattern and exclusion of other known causes of ILD. When
Quick Response Code: these conditions are fulfilled, the need for lung biopsy can
Website: be obviated. A biopsy needs to be performed for atypical
www.ijri.org
presentations, both clinical and radiological, or when the
exposure is to a new or poorly characterized agent.
DOI:
10.4103/0971-3026.125564
Imaging plays an indispensable role in the evaluation of
occupational lung disease. The radiograph of chest is the
Indian Journal of Radiology and Imaging / November 2013 / Vol 23 / Issue 4 287

(B) Coronal reformation upper lobes.[Downloaded free from http://www. As HRCT detects silicosis. May 11. The findings were evaluated in the background of occupational history. where the imaging disease. Occupations such as morphological feature of respiratory manifestation more mining.162. Axial HRCT of ground-glass opacity. we briefly review the high-resolution role of chest radiography in accurately and inexpensively computed tomography (HRCT) appearance of a wide displaying a wide range of pulmonary pathology. acute exposure to To overcome the concern of radiation exposure. and may be sufficient. It is indicated as a thorough investigation manufacturing. Also a well-spread awareness of certain dusts like asbestos as a Acute Silicosis definite carcinogen among workers has lead to demand of more sensitive screening for dust-related respiratory diseases. can be nonspecific and the sensitivity low.: HRCT in occupational lung disease most important diagnostic tool for evaluation. a stone crusher with silicosis. well-defined nodules in the small nodules with crazy paving appearance. Cost and availability of the test as well as radiation issues are the It occurs in two clinical forms: Acute silicosis and classic reasons of excluding CT from screening tests. The application Silicosis is caused by the inhalation of fine particles of CT to the occupational lung diseases attempts to describe of crystalline silicon dioxide. glass for positive cases screened by chest radiograph. It has been proved beyond doubt that CT.ijri. CT as a screening modality is still a question of debate. roadwork. Despite the well-established In this article. It can be T1W and T2W sequence whereas a lung cancer would be unique or highly suggestive of an occupational disorder hyperintense on T2W sequence. technique and acquisition of limited number of slices can be introduced while using CT for screening purposes. (A. construction. Acute silicosis occurs after a very large. W:1600) shows a geographic distribution Figure 2: A 62-year-old man. foundry working. equally well spectrum of occupational lung diseases. and image (C:-600.[1.2] distinguishing between progressive massive fibrosis (PMF) and lung cancer. along with an appropriate exposure history. particularly findings were not specific. multifocal patchy ground-glass of patients with occupational lung disease.253. C) Axial HRCT image (C:-600. a low dose silica dust. ceramics adjacent to pathology. Classic silicosis is further classified as simple or pulmonary involvement of the occupational lung diseases complicated. quarrying. and is free from considerable interobserver variation in its interpretation. intervention to exposed carcinoma. primarily among sandblasters. drilling.org on Wednesday. et al. missing as many and histopathologic diagnosis was obtained through as 10 to 15 percent of cases with pathologically documented transbronchial or CT-guided biopsy. high-resolution CT (HRCT). and consolidation with occasional crazy paving. 2016. It is helpful for opacities. W: 1600) shows small. interlobular septal thickening (arrow in C). IP: 182. The complications include tuberculosis and earlier than conventional radiographs. Coalescence of subpleural nodules forms pseudoplaques shows extensive but asymmetric involvement of both lungs (arrows) 288 Indian Journal of Radiology and Imaging / November 2013 / Vol 23 / Issue 4 . The utility of manufacture and tunnelling are associated with silicosis.198] Satija. to establish a diagnosis. Magnetic HRCT findings [Figure 1] include multiple bilateral resonance imaging (MRI) has a limited role in evaluation centrilobular opacities. PMF will show hypointense signal on both Classic Silicosis Simple form Simple silicosis is characterized by the presence of multiple A B C Figure 1 (A-C): A 38-year-old mason with silicoproteinosis. is superior to chest radiography in the detection of parenchymal abnormalities. individuals in earlier stages would show better outcome. sandblasting. The HRCT findings established limitations have been documented. is more accurate in Silicosis providing differential diagnosis.

et al. They calcification is observed within the nodules in 30% of typically show a perilymphatic distribution.253.9] The subpleural nodules may aggregate to form pseudoplaques. Progressive massive fibrosis occurs less frequently than in Lymph node calcification occurs less frequently. These nodules have less distinct margins with granular Complicated Form appearance than those of silicosis and are smaller. D) show large. accompanied by development of Figure 4: Silicotuberculosis in a 52-year-old stoneworker. calcification. The CT appearance includes focal soft-tissue masses. partially calcified fibrotic normal areas of lung suggest the diagnosis of sarcoidosis.org on Wednesday.198] Satija. kaolin. and subpleural regions. accompanied by calcifications. With progressive fibrosis. and rapid disease progression [Figure 4]. typically measuring more than 1 cm in diameter. Subpleural nodules have rounded or triangular configuration resembling pleural plaques on confluence [Figure 2]. W:350) and of focal or multifocal abnormalities intermixed with near lung windows (C:-600. cavitation. develops through confluence of individual silicotic nodules. Presence of reticular opacities and beaded septa is more characteristic of sarcoidosis and PLC. masses in the upper lobes (arrows) and peripherally calcified (eggshell) In silicosis and coal workers pneumoconioses. May 11. the nodules mediastinal and hilar lymph nodes (arrowheads) appear bilaterally symmetrical and show uniform distribution. 1-5 mm sized nodules. On CT. Central clustering of Figure 3 (A-D): A 49-year-old man working in glass manufacturing industry. IP: 182. W: 1600) shows an irregular thick-walled cavitary paracicatricial emphysema. Figure 5: Coal worker pneumoconiosis in a 62-year-old man who worked for 20 years in a coal mine.[3] The distribution may be diffuse. these large opacities migrate towards hila. nodules in peribronchovascular distribution and presence Contrast-enhanced CT images in mediastinal (A. Coal Worker’s Pneumoconiosis Coal worker ’s pneumoconiosis (CWP) results from exposure to washed coal or mixed dust consisting of coal.ijri. W: 1600) obtained at Simple Form the level of the aortic arch shows numerous small centrilobular (arrows) and subpleural (arrowheads) nodules in both lungs The CT features include diffuse. Indian Journal of Radiology and Imaging / November 2013 / Vol 23 / Issue 4 289 . though upper lobe with posterior zone predominance is characteristic. Silicotuberculosis with areas of paracicatricial emphysema Radiologic features include asymmetric nodules or consolidation.162. lesion (arrow) in the upper lobe of right lung.[8. mica. These can be differentiated on the basis of history and careful c d evaluation of computed tomography. Eggshell pattern of calcification of lymph nodes [Figure 3] is common.[4. with irregular margins. Hilar a b and mediastinal lymphadenopathy may precede the parenchymal lesions. suggestive of pulmonary tuberculosis. and commonly involving apical and posterior segments of the upper lobes.: HRCT in occupational lung disease small nodules. HRCT shows perilymphatic distribution with nodules being observed in centrilobular. silicosis. W: 1600) (C. Axial HRCT (C:-600. seen as large masses of more than 1 cm in diameter.7] [Figure 3]. surrounded by areas of emphysematous change[6.5] The differential diagnosis include sarcoidosis and pulmonary lymphangitis carcinomatosis (PLC). 2016. Complicated form Complicated silicosis. small. and silica. centrilobular predominance may be observed [Figure 5]. B) (C:50. paraseptal. Axial HRCT scan (C:-600. 2-5 mm in diameter [Figure 2]. but sometimes patients and develops as a central nodular dot. also known as progressive massive fibrosis. most numerous in the upper lung zone. with complicated silicosis and progressive massive fibrosis.[Downloaded free from http://www. Multiple ill-defined nodular lesions seen in both lungs.

traction Asbestosis bronchiectasis. Paracicatricial emphysema develops with growth of large opacities. “comet tail sign” round or oval in shape.org on Wednesday. IP: 182.198] Satija. either effusion or thickening. focal irregular areas of pleural thickening. Axial and coronal HRCT image (C:-600.[13. building maintenance.253. CT image in lung (A) (C:-600. insulation material. coal worker’s pneumoconioses. 2016. W: 1600) and mediastinal (B) (C: 50.: HRCT in occupational lung disease These masses[10] develop in mid zones or the periphery of upper lung and migrate toward hila. Normal extrapleural fat. Asbestos-Related Pleural Disease Although quite uncommon. subpleural focus of consolidation (arrow). HRCT findings [Figure 9] include subpleural asbestosis from other causes of pulmonary fibrosis. et al. As the effusion regresses. with or without infection. the parietal pleura [Figure 7]. pleural effusion is the earliest manifestation. A B Figure 8 (A. Interstitial lung fibrosis (pattern similar to usual or nonspecific interstitial pneumonia) develops in less than 20% of coal workers and there is associated increased incidence of lung carcinoma. and segments of intercostals veins can sometimes mimick pleural thickening. lymphangiomyomatosis. shipbuilding and repair. with asbestos-related pleural disease. industries manufacturing brake linings and pads. Visceral pleural thickening can be seen in diseases producing pulmonary fibrosis. parenchymal bands. Axial CT image in mediastinal window (C:-600. transverses thoracic and subcostalis muscles. W: 350) windows shows a round. HRCT shows a peripheral mass abutting the pleura.[15] poorly defined centrilobular nodules. thickening of interlobular septa. These are seen as discrete. ground-glass opacity.[Downloaded free from http://www. milling. and lymphangitic spread of carcinoma.[14] These most commonly develop along the postero-lateral chest wall between the sixth and tenth ribs and along the central diaphragm with relative sparing of apices and costophrenic angles.[11] Figure 6: A 57-year-old male coal miner with complicated progressive Asbestos-Related Lung Disease massive fibrosis. bricks. nontuberculous mycobacteria. commonly affecting Figure 7: A 72-year-old man working in clutch plate manufacturing unit. mining. diffuse thickening of the affected visceral pleura develops in more than 50% of patients. W: 1600) shows calcified pleural plaque (arrowhead) Parietal pleural thickening or pleural effusion associated with lung disease can be seen in rheumatoid arthritis. and occasionally honeycombing. leaving emphysematous spaces between them and pleura [Figure 6]. tiles. W: 1600) shows large fibrotic mass in the right upper lobes (arrow) surrounded by numerous smaller nodules Asbestos exposure is seen in construction trades.ijri.[13] Pleural plaques are the most common manifestation. B): A 54-year-old man with asbestos-related pleural Rounded Atelectasis disease and rounded atelectasis.14] The presence of pleural disease and poorly defined centrilobular This refers to interstitial fibrosis secondary to asbestos nodules in the subpleural regions is helpful in differentiating exposure.162. bronchovascular structures spiraling into the mass. May 11. with or without lung distortion and (arrowheads) with a curving tail of bronchovascular structures spiraling into the mass (comet tail sign) [Figure 8]. subpleural ipsilateral pleural abnormality. tuberculosis.[12] These are usually exudative and may be unilateral or bilateral. and linings of furnaces and ovens. This is intimately related This is also known as asbestos pseudotumor or Blesolvsky’s to the adjacent pleural plaque and thickening with a curving tail of sign. There is associated curvilinear opacities. and automobile and railroad work. 290 Indian Journal of Radiology and Imaging / November 2013 / Vol 23 / Issue 4 . which may cavitate.

circumferential pleural thickening is highly suggestive [Figure 10]. suggestive oxide. Figure 11 (A-D): Calcicosis in a 52-year-old marble worker. ground-glass opacity. involving mediastinal pleura and encasing the left lung Berylliosis is a chronic granulomatous hypersensitivity reaction occurring in both acute and chronic forms.[19] Figure 10: A 69-year-old man with mesothelioma.162. and bronchial wall thickening.17] Talcosis Talc is hydrated magnesium silicate used in the leather.[20] Mediastinal and hilar lymphadenopathy is seen in about 25% of patients. and magnified HRCT images (C:-600. Beryllium exposure occurs in industries such as nuclear power. rubber. HRCT findings [Figure 11] are not well established. and cosmetic industries.g. HRCT findings [Figure 12] include small centrilobular and subpleural nodules and heterogeneous conglomerate masses with internal foci of high attenuation that correspond to talc deposition. W: 1600) show A diagnosis of chronic beryllium disease requires a small diffuse nodules (arrow D) and some subpleural compounding lung biopsy proving granulomatous inflammation and pseudoplaques (arrowheads).ijri. 2016. Pure limestone itself does not cause pneumoconiosis..[Downloaded free from http://www. B. silica dioxide and aluminium the level of the liver dome with the patient prone shows patchy ground- glass opacities and interlobular septal thickening (arrows). paper.198] Satija. Small nodules have been described in calcicosis. The histology and radiological appearance of chronic C D beryllium disease is indistinguishable from sarcoidosis. A B HRCT findings of chronic berylliosis [Figure 13] are similar to those of sarcoidosis and include small nodules with peribronchovascular distribution. W: 350) image shows nodular Berylliosis enhancing pleural thickening.253. ceramics. W: 1600) obtained at contain magnesium oxide. W: 350) evidence of sensitivity to beryllium shown at blood shows pseudoplaque (arrowhead) testing or in bronchoalveolar lavage fl uid [beryllium lymphocyte proliferation test (BeLPT)]. Calcicosis Calcicosis is caused by inhaling limestone dust.: HRCT in occupational lung disease Mesothelioma Unilateral pleural effusion is the most frequent manifestation. BeLPT has suspected cases. et al. The acute cases have practically been eliminated through observation of strict workplace protection rules. Contrast-enhanced CT in mediastinal window (C: 50.org on Wednesday. IP: 182. e. (A.[16. A combination of mediastinal pleural involvement and thick (>1 cm). Axial HRCT scan (C:-600. aerospace. and dentistry. nodular. of early-stage asbestosis Calcicosis is caused by inhaling limestone dust. ‘‘sarcoidosis’’ patients exposed to become a standard tool in the clinical screening of metals. coronal. Indian Journal of Radiology and Imaging / November 2013 / Vol 23 / Issue 4 291 . metal manufacturing. Limestone Figure 9: Asbestosis in a 53-year-old man who worked for 30 years in consists predominantly of calcium carbonate but may also an automobile factory.[18] Talc exposure may occur as a result of inhalation or by intravenous administration. ceramic. paint. May 11. Mediastinal window (C) (C: 50. smooth or nodular interlobular septal thickening. plastics. building. D) Axial.[1] which occurs most often during recreational drug use.

It is a spectrum of diseases HRCT findings [Figure 15] consist of bilateral ground-glass opacities. and mosaic Axial HRCT image (C:-600. Axial HRCT images (A) (C:-600.org on Wednesday. reticular opacities. formerly classified as giant giant cell interstitial pneumonia and interstitial fibrosis. (C) Mediastinal window (C: 50. W: 1600) show interlobular septal thickening. small high-attenuation material (curved arrow). tiny nodules. fine nodules.[21] tungsten carbide. traction bronchiectasis and consolidation. et al. a cell interstitial pneumonia. conglomerate mass is seen to contain images (C:-600. (A. C) (C: 50. the earliest manifestations. W: 1600) shows numerous poorly defined attenuation. A a B C b c Figure 12 (A-C): Talcosis in a 63-year-old woman working in rubber industry. and a mosaic pattern of attenuation. B) Axial HRCT windows (B. peribronchial lymph nodes (arrows. W: 350).198] Satija. C) (straight arrow)]. Axial HRCT image (C:-600. May 11. W: 350) shows mediastinal and bilateral hilar lymphadenopathy Figure 14: Hard metal (nickel) pneumoconiosis in a 52-year-old lathe machine worker. Lower lobe predominance has been described.: HRCT in occupational lung disease Hard Metal Pneumoconiosis comprising occupational asthma and obliterative bronchiolitis [Figure 14]. and Hard metal pneumoconiosis. showing chronic berylliosis. bilateral central cylindrical bronchiectasis.162.ijri. suggestive of obliterative bronchiolitis centrilobular nodules in the upper lobes 292 Indian Journal of Radiology and Imaging / November 2013 / Vol 23 / Issue 4 . cobalt and diamond dust produced in hard-metal industry.[Downloaded free from http://www. IP: 182. W: 1600) shows minimal Figure 15: A 38-year-old machinist with hard metal pneumoconiosis. In the mediastinal manufacturing unit.253. W: 1600) show small Figure 13 (A-C): A 45-year-old woman working in dental prostheses centrilobular nodules (black arrows) in upper lobes. results from exposure to late feature. 2016. it is also seen in mediastinal perilymphatic nodules [subpleural (curved arrow).

develops as a result of repeated symptomatic disease with interstitial fibrosis has been inhalation of antigenic organic and low molecular weight described in arc welders. Other occupations at risk include diffuse honeycombing resembling idiopathic pulmonary mining and processing of iron ores. worker.: HRCT in occupational lung disease Siderosis It is associated with pulmonary fibrosis. et al. ground-glass attenuation. mills. grinding or polishing of aluminium into acute. IP: 182. Axial HRCT images (C:-600. It is traditionally grouped both clinically and radiogically aluminium arc welding. Common industrial antigens causing fibrosis include septal thickening with or without HP include isocynates (paint sprays). and thermophilic Aluminum Dust Pneumoconiosis actinomyces (agriculture). subacute. May 11. 2016.198] Satija.25] HRCT [Figure 16] shows widespread ill-defined small centrilobular nodules and. patchy areas of Hypersensitivity Pneumonitis ground-glass attenuation without zonal predominance.[24. HRCT findings include subpleural or oxyacetylene welders.[27] In subacute HP [Figure 20]. or irregular reticulation [Figure 18]. Mycobacterium avium complex (metal working fluids). centrilobular nodules resembling silicosis.[26] products or in the manufacture of aluminium based abrasive grinding tools. reticular opacities. and Figure 19: Isocyanate-induced acute hypersensitivity pneumonitis in areas of low attenuation. Though siderosis is not usually Hypersensitivity pneumonitis (HP). Axial HRCT image (C:-600. with areas of ground-glass attenuation. granuloma formation. with upper lobe predominance. iron and steel rolling fibrosis (IPF). less commonly. [22] extrinsic allergic alveolitis. Sparse thin-walled cysts occur in about 10% of patients and mild mediastinal lymphadenopathy develops Figure 16: Siderosis in a 39-year-old arc welder who presented with complaint of cough.[18] Emphysema is often seen. [23] Findings of interstitial inorganic particles.org on Wednesday. and small poorly defined nodules predominatly in the lower lung zones. Axial HRCT images (C:-600. and The majority cases of siderosis are seen in electric-arc and alveolar proteinosis. and chronic forms. Axial HRCT scan (C:-600. with upper areas of consolidation and ground-glass attenuation in both lungs and lobe predominance less profuse small nodular hyperattenuating areas Indian Journal of Radiology and Imaging / November 2013 / Vol 23 / Issue 4 293 . desquamative interstitial pneumonia (DIP).253. Aspergillus (agriculture). a 36-year-old man. suggestive of honeycombing (straight arrow). W: 1600) show interlobular and intralobular septal thickening with honeycombing (arrow) in bilateral upper lobes Figure 18: A 62-year-old man with history of exposure to aluminum for 18 years. small (<5 mm) and poorly defined centrilobular nodules. foundry workers and silver polishers. the HRCT findings include patchy or diffuse ground-glass opacity. W: 1600) shows patchy There is diffuse asymmetric involvement of bilateral lungs. Exposure to aluminium occurs in production of aluminium. W: 1600) shows intralobular interstitial thickening (curved arrow). and patchy lobular air trapping.[Downloaded free from http://www. W: 1600) show multiple small and poorly defined centrilobular nodules in the upper Figure 17: Siderosis with interstitial fibrosis in a lathe machine lobe of both lungs. plastics (packing honeycombing [Figure 17]. also known as associated with fibrosis or functional impairment.ijri. HRCT findings in the acute phase [Figure 19] consist of diffuse ground-glass opacity. plants).162.

though not common. These vanadium). The HRCT findings of chronic HP [Figure 21] paraquat. It comprises humidifier fever (office HRCT findings include mosaic attenuation with air trapping on expiratory imaging [Figure 22]. and mosaic attenuation with air trapping on develop weeks to months after the exposure. of bronchiectasis. smoke). ill-defined centrilobular pulmonary edema. W: 1600) show patchy ground-glass opacity and lobular hyperlucency. (A. D) Figure 22: Popcorn plant worker with obliterative bronchiolitis. bronchiectasis. mosaic perfusion. W: 1600) shows areas of bilateral consolidation. suggestive of air trapping A B C D Figure 23 (A-D): Paraquat poisoning in a 19-year-old man. with relative sparing of the lung bases. findings reflect fibrosis.198] Satija. presumably due to including ground-glass opacities. hydrogen sulfide. and metal (cadmium. May 11. without evidence of HP.162. Axial Axial HRCT obtained after 8 weeks shows reticular opacities and HRCT images (C:-600. suggestive of air trapping indicating progression to interstitial fibrosis 294 Indian Journal of Radiology and Imaging / November 2013 / Vol 23 / Issue 4 .: HRCT in occupational lung disease in about 50%.org on Wednesday. Figure 21: Chronic hypersensitivity pneumonitis in a 55-year-old plastic industry worker. W: 1600) show mosaic attenuation with areas traction bronchiectasis corresponding to the affected areas in A and B. and show middle and lower lung zone predominance. Axial HRCT at day 2 of admission (A. is a significant cause of occupational lung disease.ijri. (C. Axial HRCT images (C:-600. presence of reticulation. architectural distortion. nitrogen oxide. Chemical Pneumonitis The inhalation of noxious chemical substances. The characteristic features include inorganic (ammonia.3-butanedione) It refers to a febrile illness following exposure to organic dust used in butter flavoring of microwave popcorn. IP: 182. These chemicals include organic (organophosphates. B) (C:-600. of hypoattenuation. mercury. suggestive of pulmonary edema. B) Transverse and coronal HRCT images (C:-600.253. 2016. et al. Bronchiolitis obliterans [Figure 24] may nodules. B): A 52-year-old farmer with subacute hypersensitivity pneumonitis. bronchiolectasis. bronchiolectasis and honeycombing. and air trapping. are extremely variable. with findings expiratory scans. polyvinyl chloride. HRCT in acute exposure [Figure 23] may show centrilobular There may be superimposition of findings of subacute HP.[Downloaded free from http://www. nickel. W: 1600) show findings of fibrosis predominantly in the upper lobes with traction A B bronchiectasis (arrow) Figure 20 (A. traction sulphur dioxide).[29] Flavor Worker’s Lung Organic Dust Toxic Syndrome Flavor worker’s lung is the development of obliterative bronchiolitis after exposure to diacetyl (2. polymer fumes. or patchy areas of ground-glass opacity. [28] Bronchial wall thickening and bronchiectasis may also be present.

29:350-6.ijri. 4.144:697-705. Fillion R. Silicoproteinosis: High-resolution CT and histologic findings. Pinheiro GA. and wood-chip fever. The radiographic findings in acute silicosis. pulmonary mycotoxicosis. Müller NL. Kim TS.15:11-22. 3. Antao VC. Am Rev Respir Dis lung (B) windows (C:-600. Rachal RE. cotton fever (byssinosis). It is indicated in symptomatic patients or patients with abnormal pulmonary function findings. Axial HRCT scan(C:-600. The presence of ground glass opacity and nodules suggest active disease which may be reversible on cessation of exposure. IP: 182. mill. Figure 26 (A-D): A 35-year-old man with asbestos-related pleural disease 7. 5. and radiological findings is essential in establishing the diagnosis in others. with a normal or questionable chest radiograph. CT assessment of silicosis in exposed workers. Müller NL. Occupational lung disease is a diverse group of preventable pulmonary diseases. Colman N. May 11. Kavakama J. consolidation (arrow). W: 350) and scan in the early detection of silicosis. Winn W. Marchiori E. AJR Am J Roentgenol C D 1987. Oikonomou A. The imaging findings [Figures 25 and 26] of byssinosis in cotton workers have been sparsely described. CT image in mediastinal (A) (C:50.org on Wednesday. Begin R.[Downloaded free from http://www. occupational history. Press HC.26:59-77. 2. W: 1600) shows bronchiectasis and areas of useful to make a specific diagnosis or limit the differential hypoattenuation throughout both lungs diagnosis. Chung MJ. Computed tomography and rounded atelectasis. grain fever. J Comput Assist Tomogr 2005.198] Satija. Han J. Young RC Jr. Suratt P.126:359-63. Kwon OJ. Terra-Filho M. Bergeron D. 6. Muller NL. Figure 24: Bronchiolitis obliterans due to chlorine inhalation from bleaching agent in a 56-year-old woman laundry worker.148:509-14. It plays a critical role in assessing disease activity. Ferreira A. Patterns of coal plaque and thickening with a curving tail of bronchovascular structures workers’ pneumoconiosis in Appalachian former coal miners. Imaging of pneumoconiosis. W: 1600) shows numerous ill-defined small nodules with ground-glass attenuation in both lungs with basal References predominance 1. Samson L.16:127-9. subpleural focus of 1991. In the presence of a history of exposure and consistent clinical features. A B High-resolution CT in silicosis: Correlation with radiographic findings and functional impairment. Indian Journal of Radiology and Imaging / November 2013 / Vol 23 / Issue 4 295 . Imaging 2003. et al. Boctor M. Lee KS. J Thorac Imaging 2001. Chong S. pig fever. This is intimately related to the adjacent pleural 8. Radiographics 2006.[30] Conclusion HRCT has assumed an increasingly important role in evaluation of patients with diffuse lung disease including occupational lung disease. however. “comet tail sign” (curved arrow) J Natl Med Assoc 1992.84:41-8. Ostiguy G. Cantin A. W: 1600) shows a round. Pneumoconiosis: Comparison of imaging and pathologic findings. whereas a combination of clinical features.253. the diagnosis of even an uncommon occupational lung disease can be suggested by Figure 25: Byssinosis in a 56-year-old woman working in a cotton characteristic HRCT findings. Axial Even when the chest radiograph is abnormal. HRCT is HRCT scan (C:-600. Begin R. It also plays an important guide in determining need. Radiology 1978. basal predominant ground-glass opacities with associated centrilobular nodules have been reported on HRCT. The characteristic radiological features suggest the correct diagnosis in some. spiraling into the mass.: HRCT in occupational lung disease and hospital workers). whereas presence of fibrosis is a marker of disease irreversibility. optimal site and type of lung biopsy. Dee P. 2016.162. Carr PG.

22.2:257.198] Satija.12:206-16. Gamsu G. Newell JD Jr. Choi SJ.162. Environ Health Perspect 10. Doig AT. A possible case of disease: Assessment with CT. Müller NL. J Radiol Imaging 2013.21:1371-91. Buschman DL. J Thorac resolution computed tomography imaging in occupational lung disease. Goddard M. Beuscart R. Remy-Jardin M.[Downloaded free from http://www.related lung cancers: Preferential 23. Asbestos: When the dust settles an imaging review of Aluminosis-detection of an almost forgotten disease with HRCT. 2016. Park CK. Moller GA. McLoud TC.162:295-300. 26. arcwelders’ pneumoconiosis. Kim KI. Silva CI. Letzel S. Clin Chest 2004. Kimura K. A case report.177:363-71. Silver SF.190:835-40. Aberle DR. Park SH.144:9-18. Choi SJ. 13.190:835-40. Roach HD. Souza Júnior AS.197:403-9. J Occup Med Toxicol 2006. 18. Davies GJ. secondary to siderosis causing symptomatic respiratory disease: Am J Respir Crit Care Med 2000. Adams H. 12. Kraus T. Radiol Clin North Am. 2002. AJR Am J Roentgenol 1985. 17. Inhalation pulmonary Cite this article as: Satija B. Epler GR. High-resolution CT in the evaluation of occupational and Spectrum of high-resolution CT and pathologic findings. Ojha UC. Akira M. Hypersensitivity lung masses: Manifestations on conventional and high-resolution pneumonitis: Evaluation with CT.org on Wednesday. Conflict of Interest: None declared. Gothi D. Cameron CH. Newell JD Jr.54:497-9. Kim CW. Park CK. Dosaka-Akita H. Spectrum of high- talcosis: High-resolution CT findings in 3 patients. McCormick LM. Occup Med (Lond) 29. Beryllium 296 Indian Journal of Radiology and Imaging / November 2013 / Vol 23 / Issue 4 .21:1371-91. AJR Am environmental disease. Kim KI. 19. Wright JL.1:79-83. 15. Radiographics 2001. Imaging Med 1955. Crane M. Radiology 1988. Newman LS. Gaensler EA. Goo JM. Williams JL. Buschman DL. Radiographics 2002.1:4. Newman LS. 28. Lee KS. Voisin C.related focal 27.19:41-4. Churg A. Pulmonary fibrosis occurrence from diffuse interstitial fibrosis-type pneumoconiosis. Disabling pneumoconiosis from limestone dust. Lee KS. Source of Support: Nil. Remy J.117:765-70. worker’s pneumoconiosis: CT assessment in exposed workers and 21. Paek DM. Miller RR. J Med Case Rep 2008. Korean J Radiol 2000. IP: 182. Imaging of occupational lung disease. Heaney LG. Mahadeva R. Uncommon pneumoconioses: CT and pathologic findings.: HRCT in occupational lung disease 9.14:635-44. 25. Beryllium 16. Woods BO. 24. Muller NL.40:43-59. Honma K. Phillips S. Radiographics 2001. et al. Lee MK. pneumoconiosis in a limestone quarry worker. Lee KS. asbestos-related disease. Br J Ind 30.22 Spec No: S167-84. Radiology 1989. Saitoh Y.173:441-5. Pneumoconiosis. et al. Lynch DA. Schaller KH. Med 1993. of Occupational Lung Disease. Inhalational lung injury causing bronchiolitis. Carrington CB. Crummy F.169:603-7.ijri. Radiology 1990. Marchiori E. J Roentgenol 2007. May 11. Han D. 20. Attanoos R. Am J Roentgenol Radium Ther Nucl Med 1973. Hilgers RD. Lynch DA. Newman LS. Radiology 1994. Radiology 1994. Akira M. Diffuse pleural thickening in an asbestos-exposed population: Radiology 1995. Pacheco K. Kelleher P. Katabami M. Findings of 11. Inorganic dust pneumonias: correlation with radiographic findings. Müller NL. Lefcoe MS. Ray CS. Angerer J.253. CT scans. The metal-related parenchymal disorders. Degreef JM. 2000. Hypersensitivity pneumonitis: 14. et al. Indian Imaging 2004. Kumar S.23:287-96. Prevalence and causes. Solitary mass in the lungs of coal miners. Lynch DA. et al. Im JG.188:334-44. Kim CW. Lee MK. Asbestos. Carl I.108(Suppl 4):685-96. Uchida Y. Coal disease: Assessment with CT.