What is the diagnosis in this patient who is a 68-year-old male retired cement factory worker with progressive shortness of breath?


For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter 

 A 68-year-old male retired cement factory worker presented with progressive exertional dyspnea and clubbing. PA and Lateral plain films were obtained.

Multiple diffuse opacities can be seen in the lower lung fields. Lateral view shows diffuse plaques in the lung parenchyma, as well as the pleura. Heart and diaphragmatic contours are poorly defined. Given the patient’s occupational exposure to asbestosis, these findings are most consistent with a diagnosis of asbestosis.

Asbestosis is a diffuse parenchymal lung disease caused by the formation of fibrous plaques in response to exposure to asbestos dust. Though environmental exposure to asbestos is now limited by regulations, there is a 10 year-to-20 year latency from exposure to symptoms so patients continue to present with asbestos-related diseases.

The severity of asbestosis seems to be proportional to the level of exposure and is usually seen in patients with a 10-plus year history of occupational exposure. Asbestos fibers in the lungs induce an inflammatory response that leads to fibrogenesis around the fibers. The process occurs bilaterally in the lower lobes, although in advanced disease, the middle and even upper lobes may be involved.

Clinical symptoms resemble those of other interstitial lung diseases and include:
• Progressive dyspnea
• Inspiritory crackles
• Clubbing
• Cyanosis (rare)
• Reduced diffusion capacity and compliance on pulmonary function tests


On plain radiograph:
• Shaggy heart sign
• “Ground-glass” opacification
• Small nodular opacities
• Ill-defined diaphragmatic contours
• Honeycombing (more severe cases)
• Pleural thickening
• Calcified pleural plaques

CT is more sensitive for detecting asbestosis and is useful in early diagnosis.
• Subpleural curvilinear opacities
• Parenchymal bands projecting in from pleura
• Ground-glass opacification
• Subpleural nodular opacities
• Thickening of interlobular septa
• Pleural plaques


Diagnosis of asbestosis is based on occupational exposure history and radiographic findings of diffuse lung disease. Pleural involvement is common in asbestosis but rare in other diffuse lung diseases. The differential diagnosis includes:

• Interstitial pneumonitis
• Idiopathic pulmonary fibrosis
• Connective tissue disease (sarcoidosis, systemic lupus erythematosis, rheumatoid arthritis)
• Other pneumoconiosis (eg silicosis)
• Pleurodesis
• Multifocal malignancy or calcified metastatic disease

Image IQ

X-Ray

 X-ray modality focus page provides information, videos, podcasts, and the latest news about industry product developments, trial results, screening guidelines, and protocol guidance that touch on the use of X-ray across the healthcare continuum, from chest, orthopedic, abdominal imaging, and more.

News

RadRounds

Diagnostic Imaging, in collaboration with the leading universities, medical centers, advocacy organizations, and professional societies, ultimately strives to bring the latest in radiology research and practice to a national audience of healthcare professionals.

Strategic Alliance Partnership

What is the diagnosis in this patient who is a 68-year-old male?

Image IQ Quiz: Patient Presents with Progressive Shortness of Breath