대한흉부영상의학회 Weekly Chest Cases

Case No : 1091 Date 2018-09-27

Courtesy of Yeo Ryang Kang, Jeung Sook Kim, Yoon Ki Cha / Dongguk University Ilsan Hospital, Gyeonggi-do, Korea
Age/Sex 80 / M
Chief ComplaintAggravated dyspnea on exertion (few years ago)

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Diagnosis With Brief Discussion

Diagnosis: Asbestosis with noncalcified asbestos plaque in both hemithoraces
Radiologic Findings: Chest radiograph (Fig. 1) shows reticular densities in both lower lungs. Lung setting image of chest CT (Fig. 2 and 3) shows subpleural dot like and branching opacities, reticular densities and bronchiolectasis in both lower subpleural portions. Mediastinal setting images of non-contrast enhanced chest CT (Fig 4 and 5) show thin noncalcified pleural plaques in both hemithoraces.
Brief Review: Asbestosis is diffuse interstitial pulmonary fibrosis that occurs secondary to inhalation of asbestos fibers. It is considered separately from other asbestos-related diseases, such as benign pleural effusion and plaques, malignant mesothelioma, and bronchogenic carcinoma.
Asbestosis manifests with the same clinical, radiologic, and histopathologic features as other forms of diffuse interstitial pulmonary fibrosis. Asbestosis may be diagnosed without lung biopsy in the presence of three clinical signs (ie, a restrictive pattern of lung impairment, a diffusion capacity below the lower limit of the normal range, and bilateral crackles at the posterior lung base in the latter part of or throughout the respiratory cycle); a history of relevant exposure; and, most important, chest radiographic findings that correspond to ILO classification.
On chest radiographs asbestosis shows small, irregular or reticular opacities, predominantly in the bases of the lungs. The opacities may progressively spread through the middle and upper lung zones. In more advanced cases, honeycombing is evident on chest radiographs. And pleural thickening or pleural plaques may also be seen.
Chest CT is much more sensitive than chest radiograph in evaluating asbestosis. The earliest CT findings in asbestosis are subpleural dot-like or branching opacities located a few millimeters from the pleura but seldom touching the pleura, or they may appear as a fine branching structure. As the subpleural dot-like or branching opacities increase in number, confluence of dots creates subpleural curvilinear lines. Such lines are defined as linear areas of increased density located within 1 cm of the pleura and lying parallel to the inner chest wall on CT. Parenchymal bands are also commonly seen in asbestosis. The bands reflect the development of fibrosis along the bronchovascular sheathes or interlobular septa, with distortion of the lung parenchyma. And these bands are associated with areas of pleural plaques and frequently occur at the lung bases. Ground-glass opacity is uncommon as an isolated abnormality in asbestosis. GGO in asbestosis reflects mild alveolar wall and interlobular thickening caused by fibrosis or edema. As the pulmonary fibrosis extends from the peribronchiolar lesions to involve the residual pulmonary lobules, other characteristic CT findings of pulmonary fibrosis develop. These include intralobular interstitial thickening, interlobular septal thickening, traction bronchiectasis or bronchiolectasis and honeycomb cysts in the lower lung, posterior, and basal subpleural areas.
References: 1. Y.K. Cha, J.S. Kim, Y.K. Kim, Y.K. Kim. Radiologic Diagnosis of Asbestosis in Korea. Korean J Radiol 2016;17(5):674-683.
2. S.M. Chong, K.S. Lee, M.J. Chung, J.H. Han, O.J Kwon, T.S. Kim. Pneumoconiosis: Comparison of Imaging and Pathologic Findings. RadioGraphics 2006; 26:59 –77.
3. Masanori Akira, Satoru Yamamoto, Yoshikazu Inoue, Mitsunori Sakatani. High-Resolution CT of Asbestosis and Idiopathic Pulmonary Fibrosis. AJR 2003;181:163–169.
Keywords: Lung, Pleura, inhalation of inorganic dust, Occupational lung disease,

No. of Applicants : 72

▶ Correct Answer : 17/72, 23.6%

- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- Other , Korea (South) SEONGSU KANG
- Onomichi municipal hospital , Japan Hirofumi Mifune
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
- Other , Korea (South) SUNGWON KIM
- Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
- CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
- , Korea (South) JIYOUNG CHOI
- , Japan NAOMI YUASA
- Ajou University Hospital , Korea (South) HYERIN KIM
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- Multimagem Diagn泥sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
- , Korea (South) JANG SEONG WON
- Chungbuk National University Hospital , Korea (South) HYEONMI RYU
- Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
- Ajou University Hospital , Korea (South) YOO YOUNGJIN

▶ Correct Answer as Differential Diagnosis : 9/72, 12.5%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- The University of Tokyo Hospital , Japan Akifumi Hagiwara
- King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
- The Jikei university , Japan TAKU GOMI
- Gifu University Hospital , Japan Yo Kaneko
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- , Japan YUMI MAEHARA

▶ Semi-Correct Answer : 1/72, 1.4%

- Samsung Medical Center , Korea (South) MIN YEONG KIM

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1091 Date 2018-09-27

Discussion

No. of Applicants : 72