Asbestosis chest x ray


 * Associate Editor(s)-In-Chief: Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA,

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 present