Pneumoconiosis diagnostic criteria: Difference between revisions

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{{CMG}}; {{AE}} [[User:Dushka|Dushka Riaz, MD]]
{{CMG}}; {{AE}} [[User:Dushka|Dushka Riaz, MD]]


== Overview ==
==Overview==
The initial imaging done for [[pneumoconiosis]] is a [[Chest X-ray|chest x-ray]]. This serves as a [[screening test]]. [[High-resolution CT]] follows and is more [[Sensitivity (test)|sensitive]] and [[Specificity|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]]. <ref name="pmid1410306">{{cite journal| author=Remy-Jardin M, Remy J, Farre I, Marquette CH| title=Computed tomographic evaluation of silicosis and coal workers' pneumoconiosis. | journal=Radiol Clin North Am | year= 1992 | volume= 30 | issue= 6 | pages= 1155-76 | pmid=1410306 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1410306  }} </ref> <ref name="pmid1987601">{{cite journal| author=Akira M, Yokoyama K, Yamamoto S, Higashihara T, Morinaga K, Kita N | display-authors=etal| title=Early asbestosis: evaluation with high-resolution CT. | journal=Radiology | year= 1991 | volume= 178 | issue= 2 | pages= 409-16 | pmid=1987601 | doi=10.1148/radiology.178.2.1987601 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987601  }} </ref> <ref name="pmid14576443">{{cite journal| author=Copley SJ, Wells AU, Sivakumaran P, Rubens MB, Lee YC, Desai SR | display-authors=etal| title=Asbestosis and idiopathic pulmonary fibrosis: comparison of thin-section CT features. | journal=Radiology | year= 2003 | volume= 229 | issue= 3 | pages= 731-6 | pmid=14576443 | doi=10.1148/radiol.2293020668 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14576443  }} </ref> <ref name="pmid33153681">{{cite journal| author=Walkoff L, Hobbs S| title=Chest Imaging in the Diagnosis of Occupational Lung Diseases. | journal=Clin Chest Med | year= 2020 | volume= 41 | issue= 4 | pages= 581-603 | pmid=33153681 | doi=10.1016/j.ccm.2020.08.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33153681  }} </ref>


== Diagnostic Study of Choice ==
==Diagnostic Study of Choice==


=== Study of choice ===
===Study of choice===
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].


OR
[[Image:Asbestosis-5.jpg|thumb|200px|left|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>]]


The following result of [gold standard test] is confirmatory of [disease name]:
1. Radiologic tests must be performed to test for [[asbestosis]] when:
* [Result 1]
* [Result 2]


OR
*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. <ref name="pmid23034792">{{cite journal| author=Darnton A, Hodgson J, Benson P, Coggon D| title=Mortality from asbestosis and mesothelioma in Britain by birth cohort. | journal=Occup Med (Lond) | year= 2012 | volume= 62 | issue= 7 | pages= 549-52 | pmid=23034792 | doi=10.1093/occmed/kqs119 | pmc=3471357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23034792  }} </ref> <ref name="pmid9322824">{{cite journal| author=| title=Asbestos, asbestosis, and cancer: the Helsinki criteria for diagnosis and attribution. | journal=Scand J Work Environ Health | year= 1997 | volume= 23 | issue= 4 | pages= 311-6 | pmid=9322824 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9322824  }}</ref>


[Name of the investigation] must be performed when:
2. The best test for [[silicosis]] is a [[High Resolution CT|high resolution CT]]:
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.


OR
*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]]. <ref name="pmid23708110">{{cite journal| author=Cullinan P, Reid P| title=Pneumoconiosis. | journal=Prim Care Respir J | year= 2013 | volume= 22 | issue= 2 | pages= 249-52 | pmid=23708110 | doi=10.4104/pcrj.2013.00055 | pmc=6442808 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23708110  }} </ref>


[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
3. [[Coal worker's pneumoconiosis]] also presents similarly to [[silicosis]] on [[HRCT]]:


OR
*[[Nodular]] opacities are seen with preference for upper lobes as well as massive [[pulmonary fibrosis]]. <ref name="pmid2217770">{{cite journal| author=Remy-Jardin M, Degreef JM, Beuscart R, Voisin C, Remy J| title=Coal worker's pneumoconiosis: CT assessment in exposed workers and correlation with radiographic findings. | journal=Radiology | year= 1990 | volume= 177 | issue= 2 | pages= 363-71 | pmid=2217770 | doi=10.1148/radiology.177.2.2217770 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2217770  }} </ref>


The diagnostic study of choice for [disease name] is [name of the investigation].
4. [[Berylliosis]] cases should have testing completed as well:


OR
*A blood beryllium lymphocyte proliferation test is the screening test of choice for those suspected of [[berylliosis]]. <ref name="pmid25398119">{{cite journal| author=Balmes JR, Abraham JL, Dweik RA, Fireman E, Fontenot AP, Maier LA | display-authors=etal| title=An official American Thoracic Society statement: diagnosis and management of beryllium sensitivity and chronic beryllium disease. | journal=Am J Respir Crit Care Med | year= 2014 | volume= 190 | issue= 10 | pages= e34-59 | pmid=25398119 | doi=10.1164/rccm.201409-1722ST | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25398119  }} </ref>
*CT scans would show [[Ground glass opacification on CT|ground glass opacities]] as the earliest sign. <ref name="pmid12362066">{{cite journal| author=Maier LA| title=Clinical approach to chronic beryllium disease and other nonpneumoconiotic interstitial lung diseases. | journal=J Thorac Imaging | year= 2002 | volume= 17 | issue= 4 | pages= 273-84 | pmid=12362066 | doi=10.1097/00005382-200210000-00004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12362066  }} </ref> <ref name="pmid21084914">{{cite journal| author=Sharma N, Patel J, Mohammed TL| title=Chronic beryllium disease: computed tomographic findings. | journal=J Comput Assist Tomogr | year= 2010 | volume= 34 | issue= 6 | pages= 945-8 | pmid=21084914 | doi=10.1097/RCT.0b013e3181ef214e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21084914  }} </ref>


There is no single diagnostic study of choice for the diagnosis of [disease name].
===Diagnostic Criteria===


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


There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
OR
[Disease name] is primarily diagnosed based on the clinical presentation.
OR
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
OR
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
=== Diagnostic Criteria ===
To be qualified as a Pneumoconiosis or [[occupational disease]] there must be four criteria met:
*This includes documented exposure to the particle.
*This includes documented exposure to the particle.
*[[Latent period]] before the development of [[symptoms]].
*[[Latent period]] before the development of [[symptoms]].
*Clinical signs and [[symptoms]] that entail the [[disease]]
*Clinical signs and [[symptoms]] that entail the [[disease]]
*Exclusion of other [[disease]] modalities. <ref name="pmid1410303">{{cite journal| author=Epler GR| title=Clinical overview of occupational lung disease. | journal=Radiol Clin North Am | year= 1992 | volume= 30 | issue= 6 | pages= 1121-33 | pmid=1410303 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1410303 }} </ref> There is no cure for the diseases and patients generally enter [[pulmonary rehabilitation]] programs and can become candidates for [[transplants]] during the end stages. <ref name="pmid30092783">{{cite journal| author=Tsang EW, Kwok H, Chan AKY, Choo KL, Chan KS, Lau KS | display-authors=etal| title=Outcomes of community-based and home-based pulmonary rehabilitation for pneumoconiosis patients: a retrospective study. | journal=BMC Pulm Med | year= 2018 | volume= 18 | issue= 1 | pages= 133 | pmid=30092783 | doi=10.1186/s12890-018-0692-7 | pmc=6085700 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30092783  }} </ref> <ref name="pmid25285970">{{cite journal| author=Laney AS, Weissman DN| title=Respiratory diseases caused by coal mine dust. | journal=J Occup Environ Med | year= 2014 | volume= 56 Suppl 10 | issue=  | pages= S18-22 | pmid=25285970 | doi=10.1097/JOM.0000000000000260 | pmc=4556416 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25285970 }} </ref>
*Exclusion of other [[disease]] modalities. <ref name="pmid1410303">{{cite journal| author=Epler GR| title=Clinical overview of occupational lung disease. | journal=Radiol Clin North Am | year= 1992 | volume= 30 | issue= 6 | pages= 1121-33 | pmid=1410303 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1410303  }} </ref>


==References==
==References==

Latest revision as of 23:00, 26 April 2021

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

Overview

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

Study of choice

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:

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

4. Berylliosis cases should have testing completed as well:

Diagnostic Criteria

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

References

  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.
  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.
  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.
  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.
  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.
  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.
  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.
  12. ↑ Epler GR (1992). "Clinical overview of occupational lung disease". Radiol Clin North Am. 30 (6): 1121–33. PMID 1410303.

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