Study Syllabus for Classification of Radiographs of Pneumoconioses

DRAFT DOCUMENT

This is a draft document meant for review only. Do not cite this document.

Clinical Overview

Central Role of Diagnostic Imaging

Overview of Nonimaging Clinical Tools in Lung Disease Diagnosis

Bronchoscopy and Surgical Lung Biopsy

For most occupational lung diseases, a careful occupational and environmental exposure history in combination with non-invasive clinical testing is adequate for diagnosis. Occasionally, however, fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsies may be clinically indicated. This is particularly true for the granulomatous lung diseases, where the finding of a lymphocytic alveolitis can be helpful in confirming a diagnosis of HP or when a positive BAL BeLPT is essential for the diagnosis of CBD. For fibrotic interstitial lung diseases (ILDs) and in some cases of presumptive occupational bronchiolitis, surgical lung biopsy may be important in confirming a diagnosis and for deciding whether systemic therapy (ie, with oral corticosteroids or immunosuppressive agents) is warranted. With the availability of newer treatment modalities for usual interstitial pneumonitis (UIP)/idiopathic pulmonary fibrosis (IPF), histologic confirmation and differentiation from similar occupational ILDs may be clinically important.

Conclusions

The diagnosis of an occupational lung disease is based on a combination of findings from history, physiological and radiological assessment. A complete occupational and environmental exposure history along with information on potential confounding factors such as smoking and co-morbid conditions are essential to diagnosis and management. When considering occupational interstitial lung diseases, the importance of imaging for diagnosis is unequivocal. Specific treatment for many occupational lung diseases is limited or unavailable, particularly for the pneumoconioses. In addition to supportive medical management, care of the affected patient may require complete cessation of exposure and referral for benefits counseling. Integration of imaging findings (including judicious use of HRCT) with other findings on clinical evaluation is important to achieve diagnostic accuracy, facilitate detection of early disease, and optimize long-term care and prevention.

Page last reviewed: November 4, 2019