Asbestosis chest x ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, Cafer Zorkun, M.D., Ph.D. [2]

Overview

  • Patients may be asymptomatic, with diagnosis made during chest x-ray (CXR) examination performed for other reasons
  • Exam often shows persistent bibasilar fine ‘’crackles’’, often at end-expiration, in one to two-thirds of patients.
    • In advanced disease, markers of severe pulmonary dysfunction may be present, such as clubbing (32-42%), cyanosis, and cor pulmonale. Patients with cor pulmonale may show peripheral edema, jugular venous distension, hepatojugular reflux, and/or a right ventricular heave or gallop.
  • Chest radiograph shows irregular linear or nodular opacities
    • These are most commonly seen initially at the bases and the periphery, and they often gradually become visible in the mid and occasionally upper zones of the lung.
    • If seen in conjunction with pleural plaques, the diaphragm and heart border may lose definition, giving rise to the “shaggy heart” sign.
    • Hilar and mediastinal adenopathy is not typical, and suggests another process.
  • Chest radiograph is about 80% sensitive for asbestosis, but chest CT is more sensitive, showing abnormalities in 30% of asbestos-exposed individuals with normal CXRs.
    • HRCT typically shows:
      • Basilar and dorsal lung parenchymal fibrosis, with peribronchiolar, intralobular, and interlobular septal fibrosis.
      • Subpleural linear densities parallel to the pleura
      • Coarse parenchymal bands, often contiguous with the pleura
      • Honeycombing in advanced disease
      • Pleural plaques may be


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