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
- Deputy Editor — Radiology
- 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, increased permeability, 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, increased permeability, 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:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Akira M. Uncommon pneumoconioses: CT and pathologic findings. Radiology 1995; 197:403.
- Choi JW, Lee KS, Chung MP, et al. Giant cell interstitial pneumonia: high-resolution CT and pathologic findings in four adult patients. AJR Am J Roentgenol 2005; 184:268.
- Weiland DA, Lynch DA, Jensen SP, et al. Thin-section CT findings in flock worker's lung, a work-related interstitial lung disease. Radiology 2003; 227:222.
- Zuskin E, Valić F, Kanceljak B, et al. [Byssinosis--an occupational disease of textile workers]. Lijec Vjesn 1996; 118:248.
- Abebe Y, Seboxa T. Byssinosis and other respiratory disorders among textile mill workers in Bahr Dar northwest Ethiopia. Ethiop Med J 1995; 33:37.
- Epler GR. Clinical overview of occupational lung disease. Radiol Clin North Am 1992; 30:1121.
- Remy-Jardin M, Remy J, Farre I, Marquette CH. Computed tomographic evaluation of silicosis and coal workers' pneumoconiosis. Radiol Clin North Am 1992; 30:1155.
- Akira M, Yokoyama K, Yamamoto S, et al. Early asbestosis: evaluation with high-resolution CT. Radiology 1991; 178:409.
- Copley SJ, Wells AU, Sivakumaran P, et al. Asbestosis and idiopathic pulmonary fibrosis: comparison of thin-section CT features. Radiology 2003; 229:731.
- Kim JS, Lynch DA. Imaging of nonmalignant occupational lung disease. J Thorac Imaging 2002; 17:238.
- Chong S, Lee KS, Chung MJ, et al. Pneumoconiosis: comparison of imaging and pathologic findings. Radiographics 2006; 26:59.
- Leung CC, Yu IT, Chen W. Silicosis. Lancet 2012; 379:2008.
- Hering KG, Jacobsen M, Bosch-Galetke E, et al. [Further development of the International Pneumoconiosis Classification--from ILO 1980 to ILO 2000 and to ILO 2000/German Federal Republic version]. Pneumologie 2003; 57:576.
- International Labour Office. Guidelines for the use of the ILO international classification of radiographs of pneumoconioses. Geneva, Switzerland: International Labour Office, 2011.
- Halldin CN, Blackley DJ, Petsonk EL, Laney AS. Pneumoconioses Radiographs in a Large Population of U.S. Coal Workers: Variability in A Reader and B Reader Classifications by Using the International Labour Office Classification. Radiology 2017; 284:870.
- Stark P, Jacobson F, Shaffer K. Standard imaging in silicosis and coal worker's pneumoconiosis. Radiol Clin North Am 1992; 30:1147.
- Parker JE, Petsonk EL. Coal worker's lung diseases and silicosis. In: Pulmonary Disease and Disorders, 3rd ed, Fishman AP (Ed), McGraw-Hill, New York 1998. p.901.
- Cox CW, Rose CS, Lynch DA. State of the art: Imaging of occupational lung disease. Radiology 2014; 270:681.
- Antao VC, Pinheiro GA, Terra-Filho M, et al. High-resolution CT in silicosis: correlation with radiographic findings and functional impairment. J Comput Assist Tomogr 2005; 29:350.
- Dee P, Suratt P, Winn W. The radiographic findings in acute silicosis. Radiology 1978; 126:359.
- Banks DE, Bauer MA, Castellan RM, Lapp NL. Silicosis in surface coalmine drillers. Thorax 1983; 38:275.
- Arakawa H, Honma K, Saito Y, et al. Pleural disease in silicosis: pleural thickening, effusion, and invagination. Radiology 2005; 236:685.
- Akgun M, Araz O, Akkurt I, et al. An epidemic of silicosis among former denim sandblasters. Eur Respir J 2008; 32:1295.
- Marchiori E, Ferreira A, Müller NL. Silicoproteinosis: high-resolution CT and histologic findings. J Thorac Imaging 2001; 16:127.
- Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008; 246:697.
- Chaouch N, Mjid M, Zarrouk M, et al. [Erasmus' syndrome with pseudo-tumour masses]. Rev Mal Respir 2011; 28:924.
- Ajlani H, Meddeb N, Sahli H, Sellami S. [Erasmus syndrome: case report]. Rev Pneumol Clin 2009; 65:16.
- Rustin MH, Bull HA, Ziegler V, et al. Silica-associated systemic sclerosis is clinically, serologically and immunologically indistinguishable from idiopathic systemic sclerosis. Br J Dermatol 1990; 123:725.
- Englert H, Small-McMahon J, Davis K, et al. Male systemic sclerosis and occupational silica exposure-a population-based study. Aust N Z J Med 2000; 30:215.
- Cointrel C, Tillie-Leblond I, Lamblin C, et al. [Erasmus syndrome: clinical, tomographic, respiratory function and bronchoalveolar lavage characteristics]. Rev Mal Respir 1997; 14:21.
- Remy-Jardin M, Degreef JM, Beuscart R, et al. Coal worker's pneumoconiosis: CT assessment in exposed workers and correlation with radiographic findings. Radiology 1990; 177:363.
- Reichert M, Bensadoun ES. PET imaging in patients with coal workers pneumoconiosis and suspected malignancy. J Thorac Oncol 2009; 4:649.
- Joshi JM, Barve KS, Basu S. Pulmonary nodules with cavitary mass in a flour mill worker. J Postgrad Med 2012; 58:328.
- Marchiori E, Lourenço S, Gasparetto TD, et al. Pulmonary talcosis: imaging findings. Lung 2010; 188:165.
- Akira M, Kozuka T, Yamamoto S, et al. Inhalational talc pneumoconiosis: radiographic and CT findings in 14 patients. AJR Am J Roentgenol 2007; 188:326.
- Marchiori E, Souza Júnior AS, Müller NL. Inhalational pulmonary talcosis: high-resolution CT findings in 3 patients. J Thorac Imaging 2004; 19:41.
- Feigin DS. Talc: understanding its manifestations in the chest. AJR Am J Roentgenol 1986; 146:295.
- Stark P. Vineyard sprayer's lung - a rare occupational disease. J Can Assoc Radiol 1981; 32:183.
- Nemery B, Abraham JL. Hard metal lung disease: still hard to understand. Am J Respir Crit Care Med 2007; 176:2.
- Moriyama H, Kobayashi M, Takada T, et al. Two-dimensional analysis of elements and mononuclear cells in hard metal lung disease. Am J Respir Crit Care Med 2007; 176:70.
- Naqvi AH, Hunt A, Burnett BR, Abraham JL. Pathologic spectrum and lung dust burden in giant cell interstitial pneumonia (hard metal disease/cobalt pneumonitis): review of 100 cases. Arch Environ Occup Health 2008; 63:51.
- Demedts M, Gheysens B, Nagels J, et al. Cobalt lung in diamond polishers. Am Rev Respir Dis 1984; 130:130.
- Tanaka J, Moriyama H, Terada M, et al. An observational study of giant cell interstitial pneumonia and lung fibrosis in hard metal lung disease. BMJ Open 2014; 4:e004407.
- Larson TC, Lewin M, Gottschall EB, et al. Associations between radiographic findings and spirometry in a community exposed to Libby amphibole. Occup Environ Med 2012; 69:361.
- Gefter WB, Conant EF. Issues and controversies in the plain-film diagnosis of asbestos-related disorders in the chest. J Thorac Imaging 1988; 3:11.
- Paris C, Martin A, Letourneux M, Wild P. Modelling prevalence and incidence of fibrosis and pleural plaques in asbestos-exposed populations for screening and follow-up: a cross-sectional study. Environ Health 2008; 7:30.
- Staples CA. Computed tomography in the evaluation of benign asbestos-related disorders. Radiol Clin North Am 1992; 30:1191.
- Aberle DR, Gamsu G, Ray CS, Feuerstein IM. Asbestos-related pleural and parenchymal fibrosis: detection with high-resolution CT. Radiology 1988; 166:729.
- Sargent EN, Gordonson J, Jacobson G, et al. Bilateral pleural thickening: a manifestation of asbestos dust exposure. AJR Am J Roentgenol 1978; 131:579.
- Wechsler RJ, Steiner RM, Conant EF. Occupationally induced neoplasms of the lung and pleura. Radiol Clin North Am 1992; 30:1245.
- Davies D, Andrews MI, Jones JS. Asbestos induced pericardial effusion and constrictive pericarditis. Thorax 1991; 46:429.
- Schneider HJ, Felson B, Gonzalez LL. Rounded atelectasis. AJR Am J Roentgenol 1980; 134:225.
- Stark P. Round atelectasis: another pulmonary pseudotumor. Am Rev Respir Dis 1982; 125:248.
- Flors L, Domingo ML, Leiva-Salinas C, et al. Uncommon occupational lung diseases: high-resolution CT findings. AJR Am J Roentgenol 2010; 194:W20.
- Sluis-Cremer GK, Thomas RG, Goldstein B, Solomon A. Stannosis. A report of 2 cases. S Afr Med J 1989; 75:124.
- Maier LA, Martyny JW, Liang J, Rossman MD. Recent chronic beryllium disease in residents surrounding a beryllium facility. Am J Respir Crit Care Med 2008; 177:1012.
- Maier LA. Clinical approach to chronic beryllium disease and other nonpneumoconiotic interstitial lung diseases. J Thorac Imaging 2002; 17:273.
- Sharma N, Patel J, Mohammed TL. Chronic beryllium disease: computed tomographic findings. J Comput Assist Tomogr 2010; 34:945.
- Newman LS, Buschman DL, Newell JD Jr, Lynch DA. Beryllium disease: assessment with CT. Radiology 1994; 190:835.
- Müller-Quernheim J, Gaede KI, Fireman E, Zissel G. Diagnoses of chronic beryllium disease within cohorts of sarcoidosis patients. Eur Respir J 2006; 27:1190.
- Glazer CS, Rose CS, Lynch DA. Clinical and radiologic manifestations of hypersensitivity pneumonitis. J Thorac Imaging 2002; 17:261.
- Hirschmann JV, Pipavath SN, Godwin JD. Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics 2009; 29:1921.
- Winningham PJ, Martínez-Jiménez S, Rosado-de-Christenson ML, et al. Bronchiolitis: A Practical Approach for the General Radiologist. Radiographics 2017; 37:777.
- Hanak V, Golbin JM, Ryu JH. Causes and presenting features in 85 consecutive patients with hypersensitivity pneumonitis. Mayo Clin Proc 2007; 82:812.
- Tateishi T, Ohtani Y, Takemura T, et al. Serial high-resolution computed tomography findings of acute and chronic hypersensitivity pneumonitis induced by avian antigen. J Comput Assist Tomogr 2011; 35:272.
- Pereira CA, Gimenez A, Kuranishi L, Storrer K. Chronic hypersensitivity pneumonitis. J Asthma Allergy 2016; 9:171.
- Lacasse Y, Selman M, Costabel U, et al. Classification of hypersensitivity pneumonitis: a hypothesis. Int Arch Allergy Immunol 2009; 149:161.
- Webb WR. Thin-section CT of the secondary pulmonary lobule: anatomy and the image--the 2004 Fleischner lecture. Radiology 2006; 239:322.
- Cormier Y, Brown M, Worthy S, et al. High-resolution computed tomographic characteristics in acute farmer's lung and in its follow-up. Eur Respir J 2000; 16:56.
- Sahin H, Brown KK, Curran-Everett D, et al. Chronic hypersensitivity pneumonitis: CT features comparison with pathologic evidence of fibrosis and survival. Radiology 2007; 244:591.
- Walsh SL, Sverzellati N, Devaraj A, et al. Chronic hypersensitivity pneumonitis: high resolution computed tomography patterns and pulmonary function indices as prognostic determinants. Eur Radiol 2012; 22:1672.
- Murphy CM, Akbarnia H, Rose SR. Fatal pulmonary edema after acute occupational exposure to nitric acid. J Emerg Med 2010; 39:39.
- Shin JS, Lee SW, Kim NH, et al. Successful extracorporeal life support after potentially fatal pulmonary oedema caused by inhalation of nitric and hydrofluoric acid fumes. Resuscitation 2007; 75:184.
- Zhang LL, Zhou SS, Liu B, et al. [A study of the clinical features and the effect of therapy on acute respiratory distress syndrome patients as a result of severe triphosgene poisoning]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2012; 24:116.
- White CW, Martin JG. Chlorine gas inhalation: human clinical evidence of toxicity and experience in animal models. Proc Am Thorac Soc 2010; 7:257.
- Charan NB, Myers CG, Lakshminarayan S, Spencer TM. Pulmonary injuries associated with acute sulfur dioxide inhalation. Am Rev Respir Dis 1979; 119:555.
- van Rooy FG, Rooyackers JM, Prokop M, et al. Bronchiolitis obliterans syndrome in chemical workers producing diacetyl for food flavorings. Am J Respir Crit Care Med 2007; 176:498.
- White CS, Templeton PA. Chemical pneumonitis. Radiol Clin North Am 1992; 30:1231.
- Kreiss K, Gomaa A, Kullman G, et al. Clinical bronchiolitis obliterans in workers at a microwave-popcorn plant. N Engl J Med 2002; 347:330.
- Lockey JE, Hilbert TJ, Levin LP, et al. Airway obstruction related to diacetyl exposure at microwave popcorn production facilities. Eur Respir J 2009; 34:63.
- Pipavath SJ, Lynch DA, Cool C, et al. Radiologic and pathologic features of bronchiolitis. AJR Am J Roentgenol 2005; 185:354.
- Khan AJ, Nanchal R. Cotton dust lung diseases. Curr Opin Pulm Med 2007; 13:137.
- Wang XR, Zhang HX, Sun BX, et al. A 20-year follow-up study on chronic respiratory effects of exposure to cotton dust. Eur Respir J 2005; 26:881.
- Romero S, Hernández L, Gil J, et al. Organizing pneumonia in textile printing workers: a clinical description. Eur Respir J 1998; 11:265.
- Kern DG, Crausman RS, Durand KT, et al. Flock worker's lung: chronic interstitial lung disease in the nylon flocking industry. Ann Intern Med 1998; 129:261.
- Sirajuddin A, Kanne JP. Occupational lung disease. J Thorac Imaging 2009; 24:310.
- Cummings KJ, Nakano M, Omae K, et al. Indium lung disease. Chest 2012; 141:1512.
- Lee J, Lee C, Kim CH. Uncontrolled occupational exposure to 1,1-dichloro-1-Fluoroethane (HCFC-141b) is associated with acute pulmonary toxicity. Chest 2009; 135:149.
- King MS, Eisenberg R, Newman JH, et al. Constrictive bronchiolitis in soldiers returning from Iraq and Afghanistan. N Engl J Med 2011; 365:222.
- 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