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Study Syllabus for Classification of Radiographs of Pneumoconioses						Print
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										Pathology OverviewPathology Basis of Occupational Lung DiseaseAsbestos-Related Pleuropulmonary Disease
In the ILO Classification, asbestosis is usually characterized by the development of small irregular opacities (s, t, u). In approximately 20% to 30% of cases, parenchymal changes are accompanied by pleural thickening with or without calcification. Rounded opacities are rarely seen in the chest radiographs of patients with asbestosis unless there has been additional exposure to silica. Progression of asbestosis may be seen radiographically as honeycomb change [Morgan and Gee 1995; Gefter et al. 1984].
Pleural changes due to asbestos exposure are identified more frequently on chest radiography than is parenchymal disease. Asbestos-related pleural effusion progressing to diffuse pleural thickening (fibrothorax) may create a ground-glass haze over the lung, associated with an obliterated costo-phrenic angle. With significant pleural fibrosis the rib spaces are crowded and there is ipsilateral loss of lung volume. Pleural plaques appear on the chest wall or diaphragm as smooth, regular linear shadows. En face plaques can closely mimic the parenchymal changes of asbestosis. Rounded atelectasis appears as a spherical or elliptical subpleural pleural-based opacity. Vessels and bronchi from the hilar region converge on the area of atelectasis, forming the “comet-tail” sign. There is pleural thickening overlying the region of atelectasis, which can simulate a lung tumor [Morgan and Gee 1995; Gefter et al. 1984].
There are no distinctive radiologic features of lung carcinoma caused by asbestos exposure. There is a tendency, however, for increased lower-lobe distribution of asbestos-related lung cancers. Within the lower lobe, asbestos-related lung carcinomas are frequently peripherally distributed. In the presence of dense parenchymal fibrosis, radiographic detection of a neoplasm may be difficult [Gefter et al. 1984]. Attribution of a carcinoma to asbestos is supported by a significant cumulative exposure history and/or, from the pathological perspective, an elevated asbestos burden in the lung parenchyma, as assessed by asbestos bodies or fiber counts.
Finally, mesothelioma usually presents as a large unilateral pleural effusion. Pleural-based solid lesions may also occur in a minority of patients. With progression, tumor replaces pleural effusion, which often becomes loculated [Morgan and Gee 1995; Gefter et al. 1984].PATHOLOGIC–RADIOLOGICAL CORRELATIONSPage 5 of 5REFERENCES
							
					
							Last Reviewed:  April 26, 2023						Source: 	National Institute for Occupational Safety and Health
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        Syndicate homeStudy Syllabus for Classification of Radiographs of Pneumoconioses
Introductionplus icon
Preface
Appreciation to Contributors
Intent of the Self-study Syllbus
Getting Started
Clinical Overviewplus icon
Major Occupational Lung Diseasesplus icon
Pneumoconioses
Central Role of Diagnostic Imagingplus icon
Role of CT
Overview of Nonimaging Clinical Tools in Lung Disease Diagnosis
Appendix A
References
Pathology Overviewplus icon
Pulmonary Silicosis
Coal Workers’ Pneumoconiosis
Asbestos Pleuropulmonary Disease
Pathological-Clinical Correlations
References
Radiograph Classificationplus icon
SUBSET 1 – Radiograph Classification, #1 to #19plus icon
Introduction
Radiograph Identification
Section 1: Image Quality
Section 2: Parenchymal Abnormalities, #1 to #14
Section 3: Pleural Abnormalities, #15 to #19
Section 4: Any Other Abnormalities
Section 5
SUBSET 2 – Radiograph #20 to #27plus icon
Radiograph #20
Radiograph #21
Radiograph #22
Radiograph #23
Radiograph #24
Radiographs #25 to #27
SUBSET 3 – Radiograph #28 to #38plus icon
Radiographs #28 to #30
Radiographs #31 to #32
Radiographs #33 to #35
Radiographs #36 to #38
SUBSET 4 – Radiograph #39 to #46 (Small and Large Opacities)plus icon
Radiographs #39 to #40
Radiographs #41 to #42
Radiographs #43 to #44
Radiograph #45
Radiograph #46
SUBSET 5 – Classifications and Answer Keys, Radiographs #47 to #83
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