Imaging of occupational lung diseases
- Paul Stark, MD
Paul Stark, MD
- Professor of Radiology
- University of California San Diego
- Section Editors
- Nestor L Muller, MD, PhD
Nestor L Muller, MD, PhD
- Section Editor — Pulmonary Imaging
- Professor of Radiology
- University of British Columbia
- Talmadge E King, Jr, MD
Talmadge E King, Jr, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Interstitial Lung Disease
- Dean, School of Medicine
- Vice Chancellor, Medical Affairs
- University of California San Francisco
- Deputy Editors
- Helen Hollingsworth, MD
Helen Hollingsworth, MD
- Deputy Editor — Pulmonary, Critical Care, and Sleep Medicine
- Associate Professor of Medicine
- Boston University School of Medicine
- Susanna I Lee, MD, PhD
Susanna I Lee, MD, PhD
- Associate Professor of Radiology
- Harvard Medical School
- Massachusetts General Hospital
A multitude of diseases can result from occupational exposure to dust, fumes, smoke, and biological agents. The most common acquired occupational lung diseases include occupational asthma, bronchitis, bronchiolitis, hypersensitivity pneumonitis, acute toxic inhalant syndromes, pneumoconioses, and tumors.
Among these, occupational asthma is likely the most common, yet it displays only limited imaging manifestations. The other diseases, including the pneumoconioses, yield characteristic imaging features that are the focus of this review. The clinical manifestations, diagnosis, and management of asbestosis, berylliosis, flock worker's lung, and silicosis, as well as a general approach to the evaluation of interstitial lung disease, are discussed separately. (See "Asbestos-related pleuropulmonary disease" and "Chronic beryllium disease (berylliosis)" and "Flock worker's lung" and "Silicosis" and "Approach to the adult with interstitial lung disease: Clinical evaluation" and "Approach to the adult with interstitial lung disease: Diagnostic testing".)
Occupational lung diseases include the pneumoconioses (interstitial lung diseases), hypersensitivity pneumonitis, bronchiolitis, byssinosis, and occupational asthma. Pneumoconioses result from inhalation and deposition of inorganic particles and mineral dust with subsequent reaction of the lung. Pneumoconioses can be subdivided into fibrogenic (eg, silica, coal, talc, asbestos), benign or inert (eg, iron, tin, barium), granulomatous (eg, beryllium), and giant cell pneumonia associated with hard metal inhalation (eg, cobalt) [1,2]. Occupational exposure to certain organic dusts, molds, and chemicals can lead to hypersensitivity pneumonitis, an inflammatory reaction that is reversible if exposure is stopped in the acute or subacute phases. In unusual circumstances, organic particles like nylon flock can induce interstitial lung disease when inhaled by workers . (See "Flock worker's lung".)
Inhalation of noxious gases and fumes can lead to noncardiogenic pulmonary edema, constrictive bronchiolitis, or irritant-induced asthma, while byssinosis refers to an acute bronchoconstrictor response to inhalation of raw cotton, hemp, or flax, especially with exposure to bales of cotton, spinning, or carding [4,5]. Except for noncardiogenic pulmonary edema, pulmonary function tests show airflow limitation, but the chest radiograph is normal. (See 'Noxious fumes and gases' below and 'Byssinosis' below.)
Four criteria have to be fulfilled in order to secure a diagnosis of occupational lung disease:
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- IMAGING CHARACTERISTICS OF PNEUMOCONIOSES
- Types of imaging findings in occupational lung diseases
- The International Labor Office classification
- FEATURES OF INDIVIDUAL PNEUMOCONIOSES
- Coal worker's pneumoconiosis
- Talcosis and talc granulomatosis
- Vineyard sprayer's lung disease
- Hard metal pneumoconiosis
- Asbestos-related thoracic diseases
- - Pleural disease
- - Asbestosis
- - Bronchogenic carcinoma
- Benign or inert dust pneumoconiosis
- Beryllium disease/berylliosis
- Hypersensitivity pneumonitis
- NOXIOUS FUMES AND GASES
- NEWER OCCUPATIONAL LUNG DISEASES