1. JK Amorosa

2. 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

3. 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

4. Asbestos  undisturbed asbestos-containing materials: no health risk  damaged or disturbed, or deteriorate over time and release asbestos fibers into building air: health risk

5. 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.

6. Occupational Lung Diseases

7. Occupations at Risk

8. Asbestos Exposure

10. 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

11. 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

12. Occupational Lung Diseases  Occupational lung diseases are caused by inhaled particles,mists, vapors or gases while at work.

13. 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

14. P N E U M O C O N I O S I S  LUNG DUST

15. Asbestos exposure  Pleural manifestations  Pulmonary manifestations

16. ASBESTOS EXPOSURE-Pleural 1. Pleural plaques 2. Pleural effusion, benign 3. Mesothelioma 4. Rounded atelectasis – always associated with chronic pleural process

17. 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

20. Dx: Asbestos related pleural plaques, marker of exposure, usually asymptomatic Findings:  Calcified pleural plaques

21. Findings: calcified pleural plaques Judith K Amorosa

22. Location of pleural plaque

24. 19911998

26. Pleural effusion

27. 55 yo man with R chest pain

28. 59 yo man with dull R chest pain

29. 19971995

30. Mesothelioma

33. Pleural Based Masses, Ddx: mesothelioma or metastatic lung ca

34. 50+ male with shoulder pain

36. Dx: mesothelioma

37. Suspect mesothelioma  Chest X-ray  CT  PET  MR chest wall and diaphragmatic involvement

38. Localized malignant mesothelioma (stage I)  Unilateral parietal or visceral pleura and pericardium

39. 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.

40. 49 yo woman with a pelvic mass  Metastatic ovarian ca

42. Rounded Atelectasis

44. Broncho-vascular bundle, “comet sign”

45. Rounded atelectasis

47. Asbestos related pleural plaques, rounded atelectasis, fibrosis: asbestosis

48. 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

50. Dx: Asbestosis and Pleural plaques

51. Pattern: Rounded atelectasis  Asbestos exposure Atypical  Silicosis

52. 83 m

54. Emphysema, plaques, asbestosis,Lung ca

56. Asbestosis; Ddx:IPF, scleroderma

57. Development of lung disease is dependent on  Intensity of exposure  Duration of exposure  Physiologic and biologic susceptibility of host

58.  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

59. Judith K Amorosa

60. Dx: Asbestosis Findings:  Calc plaques  Pulmonary fibrosis Judith K Amorosa

62. Lung Cancer

63. NIOSH: National Institute of Occupational Safety and Health

64. Silicosis

65.  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.

66. Miliary pattern: TB, histo, coccydio, mets, silicosis Judith K Amorosa

67. Alveolitis – acute silicosis

68. Dx: Complicated Silicosis, CWP PMF or conglomerate masses Findings:  Upper lobe symmetrical masses  Upper lung nodules

69. Complicated silicosis: PMF

72. Silicosis, complicated (PMF, Conglomerate mass), Ddx: Sarcoid, TB

74. Complicated silicosis in a 58-year-old man. Kim K et al. Radiographics 2001;21:1371-1391 ©2001 by Radiological Society of North America

76. Pattern  Silicosis- upper lung nodules  Asbestosis -lower lung linear opacities

77. Pattern: Consolidation  Acute silicosis  Hypersensitivity pn  Ardystil syndrome (Spain- printing fabric by spraying with pulverized dyes)  Flockworkers lung disease (Rhode Island car upholstery)

78. radiologyassistant

79. Acute exposure-inhalation to aerosolized (airborne) fibers, fumes, mists, dust – toxins, chemicals

80. Pattern: GG  Acute Silicosis  Hypersensitivity pn  Hard metal  Flockworkers lung  Indium-tin oxide Rarely  Chronic beryllium  Asbestosis  Siderosis  Accelerated silicosis

82. HP glassblower

83. 60 m GG pattern

84. Pattern: crazy paving  Acute silicosis  Indium-tin oxide (ITO)

87. Eosinophilic Pneumonia

88. 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

89. radiologyassistant

90. 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

91. Pattern: Perilymphatic/subpleural nodules  Chronic Silicosis  CWP  Chronic beryllium dis  Talcosis  Calcinosis  Stannosis  HMLD  Aluminosis  Accelerated silicosis  Asbestosis

92. Pattern: Fibrosis (UIP, NSIP patterns)  Asbestosis  Hypersensitivity pn Atypical  Chronic silicosis  CWP  Chronic beryllium  HMLD  Siderosis  Ardystil S  Flock workers lung  ITO  Aluminosis

93. Pattern: Masses  Complicated silicosis (PMF)  CWP  Talcosis  Atypical  Siderosis  Chronic beryllium disease

94. Pleural Plaque

95. Etiologies of Interstitial Pulmonary fibrosis include 1. Scleroderma 2. Idiopathic 3. Asbestosis 4. Silicosis

97. Acute Hypersensitivity Pneumonia

98. 83 f

99. AIP vs HP

100. In the secondary Pulmonary Lobule the bronchiole is located 1. Along the pulmonary vein 2. Along the interlobular septum 3. Along the pulmonary artery

101. American Journal of Roentgenology. 2001;177: 501-519. 10.2214/ajr.177.3.1770501

102. Sequiosis (red wood) Judith K Amorosa

103. Mushroom workers’ pneumoconiosis is organic

104. 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

105.  Hypersensitivity pneumonitis  Respiratory bronchiolitis in smokers  infectious airways diseases (endobronchial spread of tuberculosis or nontuberculous mycobacteria, bronchopneumonia)  Uncommon in bronchioloalveolar carcinoma, pulmonary edema, vasculitis

106. Organic Pneumoconiosis is 1. Asbestosis 2. Mushroom worker’s disease 3. Silicosis 4. Berylliosis

107. Silicotic nodules 1. Peribronchiolar 2. Upper lobes and perihilar 3. Lower lobes 4. Coalesce: PMF

108. Organic Pneumoconiosis is 1. Asbestosis 2. Mushroom worker’s disease 3. Silicosis 4. Berylliosis

109. Subacute HP  Ill defined centrilobular GGO nodules  Relative sparing c air- trapping  Eur Respir Rev June 1, 2010 vol. 19 no. 116 97- 108

110. Organic  Hay  Malt  Mushroom  Barley  Cotton (byssinosis)  flax

111. Pneumoconiosis - most common  Asbestosis  Berylliosis  Byssinosis  CWP (Coal Workers Pneumoconiosis)  Silicosis Kun –Kim et al November 2001 RadioGraphics, 21, 1371-1391.

112. Reactions  Acute Inflammation Edema  Chronic Fibrosis Granuloma

113. jd.

114. jd

116. Jd Ddx: Sarcoidosis, Complex silicosis

117. Siderosis  Iron ore miners  Welders  Steel workers  Fibrosis  Obstructive airway disease  Lung ca

118. Byssinosis (brown lung)  Exposure to dust from cotton, hemp and flax  Causes blockage of small airways  ?? Endotoxin release from cell walls of Gm- bacteria

119. 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

120. 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

121. ABR questions about  application, analysis, management