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JK Amorosa
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State of the Art Imaging of Occupational Lung Disease Cox, C et al Radiology 2014, 270: 681- 696 Team approach: occupational med physician, pulmonologist, radiologist Exposure hx, PE, Lab, Pulmonary function, imaging, bronchoscopy/Sx
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Asbestos fibrous mineral: amphiboles/ banned since 1970s chrysotile fibers still used in: construction materials: roofing, siding shingles, pipe and boiler insulation, floor/ ceiling tiles carcinogen years following asbestos exposure
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Asbestos undisturbed asbestos-containing materials: no health risk damaged or disturbed, or deteriorate over time and release asbestos fibers into building air: health risk
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WHO 200,000 people die each year from cancers related to their workplaces, mainly from inhaling asbestos fibers and second-hand tobacco smoke. 125 million people worldwide are exposed to asbestos at work and every 10th lung cancer death is related to occupational hazards, which amount to at least 90,000 deaths each year.
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Occupational Lung Diseases
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Occupations at Risk
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Asbestos Exposure
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Occupations Miners Millers Cement workers Construction Demolition Railroad workers Pipe fitters Shipyard workers Fertilizer manufacturers Brake repair Pharmaceuticals Diesel exhaust Fire fighters Aircraft workers Plastics Steel workers Explosives Ceramics Fuels Sanders Welders Polishers Paint Boiler makers Bleach Textiles Chrome plating Floor tilers Paper industryPigments Oil/ Petroleum Refinery workers Chemistry Electronics Dye Bricklayers Farmers US Navy Sewer cleaners Atomic energy Roofers Rubber
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Asbestos: mineral Composition: Silicon Oxygen Hydrogen Calcium Sodium Metals: magnesium, iron Characteristics: Strength Flexibility Low electrical conductivity Resistant to heat and chemicals Greek origin means: inextinguishable, or indestructible
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Occupational Lung Diseases Occupational lung diseases are caused by inhaled particles,mists, vapors or gases while at work.
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Asbestos Exposure in 3000 commercial products 1940 - 1979 US 27 million people occupational exposure to asbestos 7% were engaged in primary mining, milling, and manufacturing of asbestos products
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P N E U M O C O N I O S I S LUNG DUST
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Asbestos exposure Pleural manifestations Pulmonary manifestations
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ASBESTOS EXPOSURE-Pleural 1. Pleural plaques 2. Pleural effusion, benign 3. Mesothelioma 4. Rounded atelectasis – always associated with chronic pleural process
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Asbestos Related Lung Disease: Asbestosis Asbestosis is the term reserved for pulmonary fibrosis caused by the inhalation of asbestos fibers. Subpleural lower lobes areas - mostly Malignant masses: lung ca Benign mass: rounded atelectasis, pleural thickening, mass contains low density centrally, has comet tail containing crowded vessels and bronchi
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Dx: Asbestos related pleural plaques, marker of exposure, usually asymptomatic Findings: Calcified pleural plaques
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Findings: calcified pleural plaques Judith K Amorosa
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Location of pleural plaque
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19911998
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Pleural effusion
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55 yo man with R chest pain
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59 yo man with dull R chest pain
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19971995
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Mesothelioma
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Pleural Based Masses, Ddx: mesothelioma or metastatic lung ca
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50+ male with shoulder pain
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Dx: mesothelioma
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Suspect mesothelioma Chest X-ray CT PET MR chest wall and diaphragmatic involvement
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Localized malignant mesothelioma (stage I) Unilateral parietal or visceral pleura and pericardium
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Advanced malignant mesothelioma (stage II,stage III, and stage IV) stage II, cancer in ipsilateral pleura, pericardium In stage III, cancer has spread to any of the following areas: The chest wall. The mediastinum. The heart. Beyond the diaphragm. The peritoneum. Cancer may have also spread to lymph nodes on the other side of the chest or outside the chest. In stage IV, cancer has spread to distant organs or tissues.
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49 yo woman with a pelvic mass Metastatic ovarian ca
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Rounded Atelectasis
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Broncho-vascular bundle, “comet sign”
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Rounded atelectasis
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Asbestos related pleural plaques, rounded atelectasis, fibrosis: asbestosis
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Asbestos Related Lung Disease: Asbestosis Asbestosis is the term reserved for pulmonary fibrosis caused by the inhalation of asbestos fibers. Subpleural lower lobes areas - mostly Malignant masses: lung ca Benign mass: rounded atelectasis, pleural thickening, mass contains low density centrally, has comet tail containing crowded vessels and bronchi
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Dx: Asbestosis and Pleural plaques
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Pattern: Rounded atelectasis Asbestos exposure Atypical Silicosis
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83 m
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Emphysema, plaques, asbestosis,Lung ca
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Asbestosis; Ddx:IPF, scleroderma
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Development of lung disease is dependent on Intensity of exposure Duration of exposure Physiologic and biologic susceptibility of host
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HRCT: Septal and centrilobular thickening, long scars, parenchymal bands, subpleural lines, honeycombing Radiograph: lower and mid lung zone reticulo-nodular process, causing “shaggy” heart border, honeycomb Asbestosis
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Judith K Amorosa
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Dx: Asbestosis Findings: Calc plaques Pulmonary fibrosis Judith K Amorosa
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Lung Cancer
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NIOSH: National Institute of Occupational Safety and Health
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Silicosis
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Small well-defined nodules of 2 to 5mm in diameter in both lungs Upper lobe predominance Nodules may be calcified Centrilobular and subpleural distribution Sometimes random distribution Irregular conglomerate masses, known as progressive massive fibrosis Often hilar and mediastinal lymphnodes.
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Miliary pattern: TB, histo, coccydio, mets, silicosis Judith K Amorosa
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Alveolitis – acute silicosis
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Dx: Complicated Silicosis, CWP PMF or conglomerate masses Findings: Upper lobe symmetrical masses Upper lung nodules
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Complicated silicosis: PMF
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Silicosis, complicated (PMF, Conglomerate mass), Ddx: Sarcoid, TB
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Complicated silicosis in a 58-year-old man. Kim K et al. Radiographics 2001;21:1371-1391 ©2001 by Radiological Society of North America
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Pattern Silicosis- upper lung nodules Asbestosis -lower lung linear opacities
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Pattern: Consolidation Acute silicosis Hypersensitivity pn Ardystil syndrome (Spain- printing fabric by spraying with pulverized dyes) Flockworkers lung disease (Rhode Island car upholstery)
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radiologyassistant
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Acute exposure-inhalation to aerosolized (airborne) fibers, fumes, mists, dust – toxins, chemicals
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Pattern: GG Acute Silicosis Hypersensitivity pn Hard metal Flockworkers lung Indium-tin oxide Rarely Chronic beryllium Asbestosis Siderosis Accelerated silicosis
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HP glassblower
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60 m GG pattern
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Pattern: crazy paving Acute silicosis Indium-tin oxide (ITO)
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Eosinophilic Pneumonia
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Pattern: centrilobular nodules Acute silicosis Hypersensitivity pn Siderosis Flock workers lung Ardyll syndrome ITO Byssinosis Accelerated silicosis Rarely: Chronic silicosis CWP(Coal Workers’s P) Aluminosis Hard metal lung
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radiologyassistant
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Hard Metal Lung Disease(HMLD), also called Giant cell Interstitial Pneumonia (GIP) Characterized by “cannibalistic” multinucleated giant cells in airspaces on BAL Powdered tungsten carbide and cobalt Called sintered carbides, hard as diamond
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Pattern: Perilymphatic/subpleural nodules Chronic Silicosis CWP Chronic beryllium dis Talcosis Calcinosis Stannosis HMLD Aluminosis Accelerated silicosis Asbestosis
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Pattern: Fibrosis (UIP, NSIP patterns) Asbestosis Hypersensitivity pn Atypical Chronic silicosis CWP Chronic beryllium HMLD Siderosis Ardystil S Flock workers lung ITO Aluminosis
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Pattern: Masses Complicated silicosis (PMF) CWP Talcosis Atypical Siderosis Chronic beryllium disease
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Pleural Plaque
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Etiologies of Interstitial Pulmonary fibrosis include 1. Scleroderma 2. Idiopathic 3. Asbestosis 4. Silicosis
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Acute Hypersensitivity Pneumonia
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83 f
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AIP vs HP
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In the secondary Pulmonary Lobule the bronchiole is located 1. Along the pulmonary vein 2. Along the interlobular septum 3. Along the pulmonary artery
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American Journal of Roentgenology. 2001;177: 501-519. 10.2214/ajr.177.3.1770501
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Sequiosis (red wood) Judith K Amorosa
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Mushroom workers’ pneumoconiosis is organic
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Secondary pulmonary lobule supplied by terminal bronchiole in the center, parallelled by the centrilobular artery Pulmonary veins & lymphatics run in the periphery of the lobule within the interlobular septa
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Hypersensitivity pneumonitis Respiratory bronchiolitis in smokers infectious airways diseases (endobronchial spread of tuberculosis or nontuberculous mycobacteria, bronchopneumonia) Uncommon in bronchioloalveolar carcinoma, pulmonary edema, vasculitis
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Organic Pneumoconiosis is 1. Asbestosis 2. Mushroom worker’s disease 3. Silicosis 4. Berylliosis
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Silicotic nodules 1. Peribronchiolar 2. Upper lobes and perihilar 3. Lower lobes 4. Coalesce: PMF
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Organic Pneumoconiosis is 1. Asbestosis 2. Mushroom worker’s disease 3. Silicosis 4. Berylliosis
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Subacute HP Ill defined centrilobular GGO nodules Relative sparing c air- trapping Eur Respir Rev June 1, 2010 vol. 19 no. 116 97- 108
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Organic Hay Malt Mushroom Barley Cotton (byssinosis) flax
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Pneumoconiosis - most common Asbestosis Berylliosis Byssinosis CWP (Coal Workers Pneumoconiosis) Silicosis Kun –Kim et al November 2001 RadioGraphics, 21, 1371-1391.
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Reactions Acute Inflammation Edema Chronic Fibrosis Granuloma
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jd.
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jd
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Jd Ddx: Sarcoidosis, Complex silicosis
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Siderosis Iron ore miners Welders Steel workers Fibrosis Obstructive airway disease Lung ca
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Byssinosis (brown lung) Exposure to dust from cotton, hemp and flax Causes blockage of small airways ?? Endotoxin release from cell walls of Gm- bacteria
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Flockworkers lung disease At Microfibres Inc in Rhode Island two young men developed interstitial lung disease Plant made carpet-like material for car upholstery. Workers cut long nylon strands into short nylon fibers called flock. The fragments were in the respirable size and were inhaled by the workers
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ITO Indium tin oxide Transparent, colorless, when deposited as a thin film on glass, it acts as an electrical conductor Used for display technology: LCD, plasma, electroluminescent, touch screen technology
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ABR questions about application, analysis, management
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