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Study Syllabus for Classification of Radiographs of Pneumoconioses

Radiograph Classification

Subset 2

Radiograph #21

Answer Key #21 (Updated 9/28/2023)

This radiograph, on initial inspection, appears to show parenchymal and pleural abnormalities consistent with asbestos exposure. Detailed analysis would follow a pattern of sequential decision-making such as that indicated below.

The technical quality of the radiograph is graded 2, improper position, rotated LAO.

The chest shows abnormalities consistent with pneumoconiosis, so Section 2A is checked “YES”.

Careful inspection of all zones reveals small irregular opacities, the size and shape of which is consistent with the definition of t opacities. The lower zones are involved. Comparison of the radiograph with the ILO Standard shows the profusion to match most closely with the ILO s/t – 1/1 Standard.

Large opacities are not present.

There are pleural abnormalities consistent with pneumoconiosis, so 3A is checked “YES”, and one proceeds to 3B.

Pleural plaques are present bilaterally both in-profile and face-on, so for 3B chest wall, R and L are marked for both in profile and face on. Plaque is also visible along the diaphragms and along the posterior mediastinum bilaterally, so R and L are marked for diaphragm and other site(s) as well. There are also fine linear calcifications noted on the left cardiac border. The soft-tissue component of the plaques is not seen along the posterior mediastinum or heart, but their presence is inferred from the calcification. This is also true for some of the plaques along the hemidiaphragms, which are visible only because of the calcification. The extent of the plaque, combined for both in-profile and face-on plaque, is over one-half the length of the lateral chest wall, so both R and L are marked as 3. The maximum width of the in-profile plaque is between 5 and 10 mm, so b is marked for both R and L.

There is no costophrenic angle obliteration, and therefore no diffuse pleural thickening. The slight pleural thickening at the left costophrenic angle is less than the lower limit for recording costophrenic angle obliteration, which is illustrated on Standard t/t – 1/1.

Section 4A is checked “YES” because there are other abnormalities present. Cardiomegaly is present, so co is marked. The symbol ca may be checked because of concern for possible tumor. Sternal wires should be noted under 4C. The patient should be advised to see his or her physician for the cardiomegaly, although this may be chronic. Significant right lower zone atelectasis should be followed-up or evaluated with chest CT.