High-Resolution CT in Silicosis

Antao, Vinicius C.; Pinheiro, Germania A.; Filho, Mário Terra; Kavakama, Jorge; Müller, Néstor L.

doi:10.1097/01.rct.0000160424.56261.bc

Cited by 59 publications

(14 citation statements)

References 30 publications

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“…Isolated mediastinal and/or hilar lymphadenopathy (IMHL) is a relatively common reason for respiratory physician referral in the UK. The differential diagnosis includes benign granulomatous disorders, for example, tuberculosis (TB) and sarcoidosis, 1 and malignancy, including lymphoma and metastatic carcinoma. Rarer causes include lymphoproliferative disorders, for example, Castleman's disease, 2 primary hypogammaglobulinaemia 3 and histoplasmosis.…”

Section: Introductionmentioning

confidence: 99%

A study of patients with isolated mediastinal and hilar lymphadenopathy undergoing EBUS-TBNA

Evison

Morris²,

Martin³

et al. 2014

BMJ Open Resp Res

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BackgroundIsolated mediastinal and/or hilar lymphadenopathy (IMHL) may be caused by benign and malignant disorders or be ‘reactive’. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a reported low negative predictive value (NPV) in IMHL, necessitating mediastinoscopy in selected patients. The aim of this study was to examine the NPV of EBUS-TBNA in an IMHL population and determine whether clinical variables differentiate between pathological and reactive IMHL.MethodsAnalysis of a prospectively maintained database of consecutive patients with IMHL referred to a single UK centre for EBUS-TBNA.Results100 patients with IMHL had EBUS-TBNA during the study (March 2010–February 2013), mean age 58.6±15.7 years, 63% men, 70% white British and mean follow-up 16.8±8.6 months. Pathological cause of IMHL established in 52 patients (sarcoidosis n=20, tuberculosis n=18, carcinoma n=7, lymphoma n=6, benign cyst n=1), 43 from EBUS-TBNA. 48/57 negative EBUS-TBNA samples were true negatives reflecting reactive lymphadenopathy in 48%. The diagnostic accuracy of EBUS-TBNA was 91% and NPV was 84.2% (95% CI 72.6% to 91.5%). Multivariate analysis of clinical covariates showed age (odds ratio (OR) 1.07, 95% CI 1.01 to 1.13; p=0.033), the presence of a relevant comorbidity (OR 9.49, 95% CI 2.20 to 41.04; p=0.003) and maximum lymph node size (OR 0.70, 95% CI 0.59 to 0.83; p=0.00004) to differentiate between reactive and pathological IMHL. Stratification of the study population according to comorbidity and maximum lymph node size (<20 mm) identified a low-risk cohort (n=32) where the NPV of EBUS-TBNA was 93.8% (95% CI 79.9% to 98.3%).ConclusionsReactive lymphadenopathy accounts for a significant proportion of patients with IMHL. In carefully selected patients with IMHL and a negative EBUS-TBNA, surveillance rather than further invasive sampling may be an appropriate strategy.

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Section: Introductionmentioning

confidence: 99%

A study of patients with isolated mediastinal and hilar lymphadenopathy undergoing EBUS-TBNA

Evison

Morris²,

Martin³

et al. 2014

BMJ Open Resp Res

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“…In a similar study by Genevois et al , micronodular lesions detected using HRCT were not related to functional parameters28 ) ; similarly, in the study by Piirila et al , nodular lesions and functional parameters were found to be incompatible, unlike with many lesions found with HRCT29 ) . In another study done by Santos Antao et al there was a negative correlation between small opacity densities detected using HRCT with total lung capacity (TLC) and FVC24 ) . In a study by Bégin et al.…”

Section: Discussionmentioning

confidence: 89%

“…Pneumoconiosis can be detected with HRCT during the subclinical phase and the patient may be removed from exposure. In a similar study by Santos Antao et al , 91% of centrilobular branching was detected using HRCT and consequently the presence of small centrilobular branches in patients with silica exposure but without typical nodular patterns was reported to help early detection of pneumoconiosis24 ) . In our study, three patients who revealed no evidence of pneumoconiosis using chest x-rays were diagnosed as pneumoconiosis using HRCT and were removed from exposure.…”

Section: Discussionmentioning

confidence: 91%

Comparison of the International Classification of High-resolution Computed Tomography for occupational and environmental respiratory diseases with the International Labor Organization International Classification of Radiographs of Pneumoconiosis

et al. 2019

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The International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases (ICOERD) has been developed for screening and diagnosis of occupational lung diseases. We evaluated the association of icoerd with the International Labor Organization (ILO) classification and respiratory functions in pneumoconiosis. Chest x-rays of patients with pneumoconiosis were classified with ilo and icoerd using hrct, irregular opacity, pleural pathology, and emphysema was detected in 78, 19, and 53 patients, and using chest x-rays in 47, 4, and 14 patients, respectively. There was a significant correlation between ILO categories and ICOERD grades. There was a negative correlation between ILO categories and FEV1% and FVC%, whereas, ICOERD grades were not correlated with FEV1% and FVC%. HRCT was superior to chest x-rays to detect pneumoconiosis in early stage, but not in evaluating pulmonary functions.

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“…The situation may become complicated when the silicotic nodules fuse to form conglomerate masses (>1 cm in size), which is characteristic of the second form of chronic silicosis, progressive massive fibrosis. Clinical signs may be identical to simple silicosis or may be more serious, with the development of central cavitation increasing the risk of mycobacterial infection, enlarged hilar or mediastinal lymphadenopathy, pleural thickening, higher risk of spontaneous pneumothorax, and weight loss [5]. Accelerated silicosis may initially have a similar pattern to simple chronic silicosis, but later the development of nodules and masses intensifies [6].…”

Section: Silica and Silicosismentioning

confidence: 99%

New Insights into Pathomechanisms and Treatment Possibilities for Lung Silicosis

Adamcakova

Mokrá

2021

IJMS

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Inhalation of silica particles is an environmental and occupational cause of silicosis, a type of pneumoconiosis. Development of the lung silicosis is a unique process in which the vicious cycle of ingestion of inhaled silica particles by alveolar macrophages and their release triggers inflammation, generation of nodular lesions, and irreversible fibrosis. The pathophysiology of silicosis is complex, and interactions between the pathomechanisms have not been completely understood. However, elucidation of silica-induced inflammation cascades and inflammation-fibrosis relations has uncovered several novel possibilities of therapeutic targeting. This article reviews new information on the pathophysiology of silicosis and points out several promising treatment approaches targeting silicosis-related pathways.

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High-Resolution CT in Silicosis

Abstract: Profusion of opacities on HRCT correlates with functional impairment. The presence of branching centrilobular structures may be helpful in early recognition of silicosis.

Cited by 59 publications

References 30 publications

A study of patients with isolated mediastinal and hilar lymphadenopathy undergoing EBUS-TBNA

A study of patients with isolated mediastinal and hilar lymphadenopathy undergoing EBUS-TBNA

Comparison of the International Classification of High-resolution Computed Tomography for occupational and environmental respiratory diseases with the International Labor Organization International Classification of Radiographs of Pneumoconiosis

New Insights into Pathomechanisms and Treatment Possibilities for Lung Silicosis

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