NIOSH logo and tagline

Study Syllabus for Classification of Radiographs of Pneumoconioses

Radiograph Classification

Subset 2

Radiograph #22

Answer Key #22

This is the radiograph of a man who was previously exposed to asbestos. There are extensive parenchymal and pleural abnormalities consistent with asbestos-related pleuropulmonary disease. Detailed analysis is as follows:

The technical quality is classified as 2 because of slight left anterior oblique rotation and superimposition of the left scapula.

Since there are parenchymal abnormalities, Section 2A is marked “YES.”

Small irregular opacities are present in the four lower zones but best seen on the left. Those on the right are partially obscured by the pleural abnormalities. The primary type of opacity is t; the secondary, s. The profusion judged by comparison with ILO Standards is graded 1/2. (the Standard Radiograph s/t – 1/1 provides the closest match with a combination of irregular opacities, but the profusion in the left middle and lower lung zones is slightly greater than that in the 1/1 Standard.) Therefore, Category 2 should be considered as an alternative. Hence, the profusion is recorded as 1 (primary consideration) over 2 (the other level considered). There are no large opacities.

Pleural abnormalities are obviously present on the right; therefore Section 3A is checked “YES,” and Sections 3B, 3C, and 3D are completed because the pleural abnormalities are consistent with those of pneumoconiosis (in this case, asbestos-related disease). The pleural abnormalities are significant and consistent with plaque and diffuse pleural thickening.

Chest wall pleural plaque is seen face on and in profile on the right. There are no pleural calcifications identified. The extent of the plaque is greater than half the vertical length of the lateral chest wall, so the extent on the right is graded 3. The maximum width of in-profile plaque on the right is about 10 mm and is therefore graded c.

Mark R in 3C, since the right costophrenic angle is blunted in comparison to the t/t – 1/1 ILO Standard Radiograph. Although there is face-on pleural plaque, there is no definite diffuse pleural thickening or calcification.The right costophrenic angle is blunted, the pleural thickening does not extend up the lateral chest wall. Keep in mind that the pleural thickening on the lateral chest wall must exceed 3 mm to be recorded. Note the separation of the blunted angle and the pleural plaque more superiorly on the right lateral chest wall.

There are other abnormalities present, therefore, Section 4A is checked “YES.” In Section 4B, aa is checked because of calcification of the aortic arch; loss of definition of the right diaphragm is indicated by checking id, and fr for an old rib fracture noted in the left 7th and 8th lateral rib.