Pneumoconiosis diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Dushka Riaz, MD

## Overview

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The initial imaging done for pneumoconiosis is a chest x-ray. This serves as a screening test. High-resolution CT follows and is more sensitive and specific. HRCT can identify those diseases missed by chest radiograph. Pathognomonic for asbestosis is pleural thickening with pleural plaques. Silicosis would show round opacities in the upper lung. Massive fibrosis can be seen in both coal worker's pneumoconiosis and silicosis. [1] [2] [3] [4]

## Diagnostic Study of Choice

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### Study of choice

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Asbestosis with pleural plaques - Case courtesy of Dr Hani Makky Al Salam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/45002">rID: 45002</a>

1\. Radiologic tests must be performed to test for asbestosis when:

* The patient has had exposure to asbestos (with Helsinki criteria indicating the dose being at least 25 fibre/ml.years)
* The CT scan would show pulmonary fibrosis, pleural thickening and pleural plaques. [5] [6]

2\. The best test for silicosis is a high resolution CT:

* It would show widespread fibrosis with bilateral nodules and evidence of involvement of lymph nodes. It can be confirmed with lung biopsy showing acellular whorls, and bi-refringent crystals of silica. [7]

3\. Coal worker's pneumoconiosis also presents similarly to silicosis on HRCT:

* Nodular opacities are seen with preference for upper lobes as well as massive pulmonary fibrosis. [8]

4\. Berylliosis cases should have testing completed as well:

* A blood beryllium lymphocyte proliferation test is the screening test of choice for those suspected of berylliosis. [9]
* CT scans would show ground glass opacities as the earliest sign. [10] [11]

### Diagnostic Criteria

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To be qualified as a pneumoconiosis or occupational disease there must be four criteria met:

* This includes documented exposure to the particle.
* Latent period before the development of symptoms.
* Clinical signs and symptoms that entail the disease
* Exclusion of other disease modalities. [12]

## References

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1. ↑ Remy-Jardin M, Remy J, Farre I, Marquette CH (1992). "Computed tomographic evaluation of silicosis and coal workers' pneumoconiosis". Radiol Clin North Am. 30 (6): 1155–76. PMID 1410306.CS1 maint: Multiple names: authors list (link)
2. ↑ Akira M, Yokoyama K, Yamamoto S, Higashihara T, Morinaga K, Kita N; et al. (1991). "Early asbestosis: evaluation with high-resolution CT". Radiology. 178 (2): 409–16. doi:10.1148/radiology.178.2.1987601. PMID 1987601.CS1 maint: Multiple names: authors list (link)
3. ↑ Copley SJ, Wells AU, Sivakumaran P, Rubens MB, Lee YC, Desai SR; et al. (2003). "Asbestosis and idiopathic pulmonary fibrosis: comparison of thin-section CT features". Radiology. 229 (3): 731–6. doi:10.1148/radiol.2293020668. PMID 14576443.CS1 maint: Multiple names: authors list (link)
4. ↑ Walkoff L, Hobbs S (2020). "Chest Imaging in the Diagnosis of Occupational Lung Diseases". Clin Chest Med. 41 (4): 581–603. doi:10.1016/j.ccm.2020.08.007. PMID 33153681 Check `|pmid=` value (help).
5. ↑ Darnton A, Hodgson J, Benson P, Coggon D (2012). "Mortality from asbestosis and mesothelioma in Britain by birth cohort". Occup Med (Lond). 62 (7): 549–52. doi:10.1093/occmed/kqs119. PMC 3471357. PMID 23034792.CS1 maint: Multiple names: authors list (link)
6. ↑ "Asbestos, asbestosis, and cancer: the Helsinki criteria for diagnosis and attribution". Scand J Work Environ Health. 23 (4): 311–6. 1997. PMID 9322824.
7. ↑ Cullinan P, Reid P (2013). "Pneumoconiosis". Prim Care Respir J. 22 (2): 249–52. doi:10.4104/pcrj.2013.00055. PMC 6442808. PMID 23708110.
8. ↑ Remy-Jardin M, Degreef JM, Beuscart R, Voisin C, Remy J (1990). "Coal worker's pneumoconiosis: CT assessment in exposed workers and correlation with radiographic findings". Radiology. 177 (2): 363–71. doi:10.1148/radiology.177.2.2217770. PMID 2217770.CS1 maint: Multiple names: authors list (link)
9. ↑ Balmes JR, Abraham JL, Dweik RA, Fireman E, Fontenot AP, Maier LA; et al. (2014). "An official American Thoracic Society statement: diagnosis and management of beryllium sensitivity and chronic beryllium disease". Am J Respir Crit Care Med. 190 (10): e34–59. doi:10.1164/rccm.201409-1722ST. PMID 25398119.CS1 maint: Multiple names: authors list (link)
10. ↑ Maier LA (2002). "Clinical approach to chronic beryllium disease and other nonpneumoconiotic interstitial lung diseases". J Thorac Imaging. 17 (4): 273–84. doi:10.1097/00005382-200210000-00004. PMID 12362066.
11. ↑ Sharma N, Patel J, Mohammed TL (2010). "Chronic beryllium disease: computed tomographic findings". J Comput Assist Tomogr. 34 (6): 945–8. doi:10.1097/RCT.0b013e3181ef214e. PMID 21084914.CS1 maint: Multiple names: authors list (link)
12. ↑ Epler GR (1992). "Clinical overview of occupational lung disease". Radiol Clin North Am. 30 (6): 1121–33. PMID 1410303.

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