Imaging diagnosis of classical and new pneumoconiosis: predominant reticular HRCT pattern

Our plain-English summary of Imaging diagnosis of classical and new pneumoconiosis: predominant reticular HRCT pattern, by A. Masanori (Insights Into Imaging, 2021).

The study

• Author: A. Masanori
• Journal: Insights Into Imaging
• Published: 2021;12(1):33
• Type of article: Review
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Our understanding of the manifestations of pneumoconioses is evolving in recent years. Associations between novel exposures and diffuse interstitial lung disease have been newly recognized. In advanced asbestosis, two types of fibrosis are seen, probably related to dose of exposure, existence of pleural fibrosis, and the host factor status of the individual. In pneumoconiosis of predominant reticular type, nodular opacities are often seen in the early phase. The nodular pattern is centrilobular, although some in metal lung show perilymphatic distribution, mimicking sarcoidosis. High-resolution computed tomography enables a more comprehensive correlation between the pathologic findings and clinically relevant imaging findings. The clinician must understand the spectrum of characteristic imaging features related to both known dust exposures and to historically recent new dust exposures.

In plain English

This critical review described how pneumoconioses (lung diseases caused by inhaled dust) with a mainly reticular (net-like) pattern look on high-resolution CT (HRCT) scans. It covered asbestosis and lung disease from talc, aluminum, hard metal, indium and nylon flock, with illustrative patient scans. Its fiber counts, frequencies and case counts came from earlier studies it cited. From that work, it described two types of advanced asbestosis: honeycombing, resembling usual interstitial pneumonia, and atelectatic induration fibrosis, showing consolidation with volume loss. One cited study found 920,000 plus or minus 1,360,000 asbestos fibers per gram of dry lung in the atelectatic induration type, versus 200,000 plus or minus 490,000 in the honeycomb type. Another examined 65 cases referred for diagnosis of an asbestos-related malignancy in a litigation context; 24 were classed as asbestosis based on exposure plus an ILO chest X-ray profusion of 1/0 or greater. Of these 24, 6 had tissue-proven asbestosis; the other 18 showed fibrosis consistent with smoking-associated pulmonary fibrosis. The author concluded that asbestosis has two types of fibrosis, probably related to exposure dose, pleural fibrosis and host factors.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative (critical) review of imaging and pathology findings, illustrated with patient HRCT images
• Who was studied: No study population of its own. The review summarized published studies and showed HRCT images of individual patients as illustrations, for example a 61-year-old man employed in the talc industry for 20 years. It did not give a total number of patients.
• Exposure: Asbestos, talc, aluminum, hard metal (cobalt-related), indium compounds (indium oxide, indium-tin oxide) and nylon flock fibers. The review did not specify asbestos fiber types. Table 1 lists jobs and products linked to each exposure.
• Main results:
  • Citing earlier work, the review described two patterns in advanced asbestosis on HRCT: honeycombing and atelectatic induration fibrosis. It described the atelectatic induration type as evolving more rapidly and as related to high exposures.
  • In a cited study, lungs with the atelectatic induration fibrosis type contained 920,000 plus or minus 1,360,000 asbestos fibers per gram of dry lung. Lungs with the honeycomb type contained 200,000 plus or minus 490,000 (p less than 0.01).
  • The review reported that cited studies found honeycombing on HRCT in 17 to 32% of asbestosis cases.
  • A cited study examined 65 cases referred for diagnosis of an asbestos-related malignancy in the context of litigation. Of these, 24 were diagnosed as asbestosis based on exposure and an ILO profusion of 1/0 or greater. Of the 24, 6 had histologically proven asbestosis, and 18 showed interstitial fibrosis consistent with smoking-associated pulmonary fibrosis.
  • A cited study evaluated 33 asbestos workers: 15 were pathologically diagnosed with asbestosis and 18 with other lung fibroses. The authors of that study concluded that subpleural lines were the only HRCT clue to asbestosis.
• The authors' conclusion: The author concluded that asbestosis has two types of fibrosis, probably related to dose of exposure, pleural fibrosis and individual host factors. The author also stated that dust exposure can cause changes indistinguishable from idiopathic pulmonary fibrosis, and that further HRCT study of pneumoconiosis is warranted.
• Limitations the authors state:
  • Four of the newly recognized dust diseases listed in Table 2 were not discussed in the text, and the author stated that further studies on each are needed.

Topics

Medical terms in this study, explained in our Lexicon: Pneumoconiosis, High-Resolution CT (HRCT), Interstitial Lung Disease, Fibrosis.

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