DOI: 10.1148/rg.261055070
Pneumoconiosis: Comparison of Imaging and Pathologic Findings1
Semin Chong, MD,
Kyung Soo Lee, MD,
Myung Jin Chung, MD,
Joungho Han, MD,
O Jung Kwon, MD and
Tae Sung Kim, MD
1 From the Department of Radiology and Center for Imaging Science (S.C., K.S.L., M.J.C., T.S.K.), Department of Pathology (J.H.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (O.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135–710, Korea. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received March 29, 2005; revision requested April 27 and received May 20; accepted May 23. Supported by the SRC/ERC program of MOST/KOSEF (R11–2002-103). All authors have no financial relationships to disclose.
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Figure 1a. Acute silicosis in a 52-year-old man who worked for 10 years as a crystal craftsman. (a, b) Axial thin-section CT scans (1.0-mm-thick sections) obtained at the levels of the ventricles (a) and the left basal truncal bronchus (b) show ground-glass opacities and mild interlobular septal thickening (arrows) in the middle and lower lobes of the right lung and in the lingular division of the upper lobe of the left lung, respectively. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a specimen obtained with video-assisted thoracoscopic biopsy in the lingula shows a fine granular eosin-ophilic material that fills the alveolar space. Note the pigment-laden perivascular and interstitial macrophages and giant cells (arrows).
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Figure 1b. Acute silicosis in a 52-year-old man who worked for 10 years as a crystal craftsman. (a, b) Axial thin-section CT scans (1.0-mm-thick sections) obtained at the levels of the ventricles (a) and the left basal truncal bronchus (b) show ground-glass opacities and mild interlobular septal thickening (arrows) in the middle and lower lobes of the right lung and in the lingular division of the upper lobe of the left lung, respectively. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a specimen obtained with video-assisted thoracoscopic biopsy in the lingula shows a fine granular eosin-ophilic material that fills the alveolar space. Note the pigment-laden perivascular and interstitial macrophages and giant cells (arrows).
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Figure 1c. Acute silicosis in a 52-year-old man who worked for 10 years as a crystal craftsman. (a, b) Axial thin-section CT scans (1.0-mm-thick sections) obtained at the levels of the ventricles (a) and the left basal truncal bronchus (b) show ground-glass opacities and mild interlobular septal thickening (arrows) in the middle and lower lobes of the right lung and in the lingular division of the upper lobe of the left lung, respectively. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a specimen obtained with video-assisted thoracoscopic biopsy in the lingula shows a fine granular eosin-ophilic material that fills the alveolar space. Note the pigment-laden perivascular and interstitial macrophages and giant cells (arrows).
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Figure 2a. Classic silicosis in a 53-year-old man who worked for 12 years in sandblasting. Photomicrographs (original magnification, x100; hematoxylin-eosin stain) show a transbronchial lung biopsy specimen. (a) Image obtained with visible light shows intraalveolar aggregation of pigmented macrophages (arrows). (b) Image obtained with polarized light shows scattered interstitial silica particles (arrows).
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Figure 2b. Classic silicosis in a 53-year-old man who worked for 12 years in sandblasting. Photomicrographs (original magnification, x100; hematoxylin-eosin stain) show a transbronchial lung biopsy specimen. (a) Image obtained with visible light shows intraalveolar aggregation of pigmented macrophages (arrows). (b) Image obtained with polarized light shows scattered interstitial silica particles (arrows).
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Figure 3a. Silicosis in a 54-year-old man who worked for 20 years as a stonecutter. (a) Chest radiograph shows multiple small nodules in both lungs, predominantly in the upper and middle zones. (b) Axial thin-section CT scan (2.5-mm-thick section) obtained at the level of the aortic arch shows multiple small nodules with similar shape and attenuation throughout the upper lobes of both lungs.
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Figure 3b. Silicosis in a 54-year-old man who worked for 20 years as a stonecutter. (a) Chest radiograph shows multiple small nodules in both lungs, predominantly in the upper and middle zones. (b) Axial thin-section CT scan (2.5-mm-thick section) obtained at the level of the aortic arch shows multiple small nodules with similar shape and attenuation throughout the upper lobes of both lungs.
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Figure 4a. Silicosis in a 56-year-old man who worked for 25 years as a stonecutter. (a) Chest radiograph shows multiple variable-sized nodular lesions in both lungs, predominantly in the upper and middle zones. (b) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the azygos arch shows multiple small nodules with a perilymphatic (centrilobular plus subpleural) distribution in the upper lobe of both lungs. Note the tendency toward coalescence of the nodules in the lung periphery (arrows).
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Figure 4b. Silicosis in a 56-year-old man who worked for 25 years as a stonecutter. (a) Chest radiograph shows multiple variable-sized nodular lesions in both lungs, predominantly in the upper and middle zones. (b) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the azygos arch shows multiple small nodules with a perilymphatic (centrilobular plus subpleural) distribution in the upper lobe of both lungs. Note the tendency toward coalescence of the nodules in the lung periphery (arrows).
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Figure 5. Simple silicosis in a 60-year-old man who worked for 12 years in a tungsten mine. Thin-section CT scan (1.0-mm-thick section) obtained with mediastinal window settings at the level of the bronchus intermedius shows eggshell calcifications (arrows) in the hilar and subcarinal lymph nodes.
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Figure 6a. Silicotuberculosis in a 52-year-old man who worked for 30 years as a stoneworker. (a) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the great vessels shows an irregular thick-walled cavitary lesion (arrow) in the upper lobe of the left lung, a finding suggestive of pulmonary tuberculosis, as well as subpleural nodular lesions in both lungs. (b) CT scan obtained at the level of the main bronchi depicts bilateral conglomerate masses (arrows), multiple small centrilobular and subpleural nodules, and enlarged mediastinal lymph nodes (arrowheads) in the right lower paratracheal and left peribronchial areas.
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Figure 6b. Silicotuberculosis in a 52-year-old man who worked for 30 years as a stoneworker. (a) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the great vessels shows an irregular thick-walled cavitary lesion (arrow) in the upper lobe of the left lung, a finding suggestive of pulmonary tuberculosis, as well as subpleural nodular lesions in both lungs. (b) CT scan obtained at the level of the main bronchi depicts bilateral conglomerate masses (arrows), multiple small centrilobular and subpleural nodules, and enlarged mediastinal lymph nodes (arrowheads) in the right lower paratracheal and left peribronchial areas.
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Figure 7a. Silicosis and progressive massive fibrosis in a 58-year-old man who worked for 30 years as a stoneworker. (a) Chest radiograph shows multiple small nodules and masses in both lungs, predominantly in the upper and middle zones, and eggshell calcifications (arrows) in the lung hilum and the mediastinum. (b) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the aortic arch shows large symmetric bilateral opacities with irregular margins (arrows) indicative of progressive massive fibrosis, as well as numerous small nodules and septal thickening (arrowheads).
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Figure 7b. Silicosis and progressive massive fibrosis in a 58-year-old man who worked for 30 years as a stoneworker. (a) Chest radiograph shows multiple small nodules and masses in both lungs, predominantly in the upper and middle zones, and eggshell calcifications (arrows) in the lung hilum and the mediastinum. (b) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the aortic arch shows large symmetric bilateral opacities with irregular margins (arrows) indicative of progressive massive fibrosis, as well as numerous small nodules and septal thickening (arrowheads).
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Figure 8a. Silicosis and progressive massive fibrosis in a 66-year-old man who worked for 10 years crushing rock with a high quartz content. (a) Chest radiograph shows large bilateral opacities (arrows) in the upper zones of the lung, as well as upward elevation of both hila. (b) Coronal CT scan (2.0-mm-thick section) obtained with mediastinal window settings shows bilateral conglomerate masses with calcifications (arrows), findings that represent progressive massive fibrosis in the upper zone of both lungs.
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Figure 8b. Silicosis and progressive massive fibrosis in a 66-year-old man who worked for 10 years crushing rock with a high quartz content. (a) Chest radiograph shows large bilateral opacities (arrows) in the upper zones of the lung, as well as upward elevation of both hila. (b) Coronal CT scan (2.0-mm-thick section) obtained with mediastinal window settings shows bilateral conglomerate masses with calcifications (arrows), findings that represent progressive massive fibrosis in the upper zone of both lungs.
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Figure 9a. Coal worker pneumoconiosis in a 62-year-old man who worked for 20 years in a coal mine. (a) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the aortic arch shows numerous small centrilobular (arrows) and subpleural (arrowheads) nodules in both lungs. (b) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a pathologic specimen obtained with a transbronchial lung biopsy shows multiple nodules (arrows) and anthracotic pigmentation in the bronchovascular bundles.
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Figure 9b. Coal worker pneumoconiosis in a 62-year-old man who worked for 20 years in a coal mine. (a) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the aortic arch shows numerous small centrilobular (arrows) and subpleural (arrowheads) nodules in both lungs. (b) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a pathologic specimen obtained with a transbronchial lung biopsy shows multiple nodules (arrows) and anthracotic pigmentation in the bronchovascular bundles.
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Figure 10a. Progressive massive fibrosis in a 64-year-old man who worked for 25 years as a coal miner. (a) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the aortic arch shows an irregularly marginated mass in the upper lobe of the right lung and multiple small subpleural and fissural nodules (arrows) in both lungs. (b) Contrast material–enhanced CT scan (5.0-mm-thick section) at a level similar to that in a, obtained with mediastinal window settings, shows a central necrotic area of low attenuation (arrows) in the mass. (c) Photograph of lobectomy specimen shows regions of central necrosis (arrows) within the black-pigmented parenchyma.
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Figure 10b. Progressive massive fibrosis in a 64-year-old man who worked for 25 years as a coal miner. (a) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the aortic arch shows an irregularly marginated mass in the upper lobe of the right lung and multiple small subpleural and fissural nodules (arrows) in both lungs. (b) Contrast material–enhanced CT scan (5.0-mm-thick section) at a level similar to that in a, obtained with mediastinal window settings, shows a central necrotic area of low attenuation (arrows) in the mass. (c) Photograph of lobectomy specimen shows regions of central necrosis (arrows) within the black-pigmented parenchyma.
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Figure 10c. Progressive massive fibrosis in a 64-year-old man who worked for 25 years as a coal miner. (a) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the aortic arch shows an irregularly marginated mass in the upper lobe of the right lung and multiple small subpleural and fissural nodules (arrows) in both lungs. (b) Contrast material–enhanced CT scan (5.0-mm-thick section) at a level similar to that in a, obtained with mediastinal window settings, shows a central necrotic area of low attenuation (arrows) in the mass. (c) Photograph of lobectomy specimen shows regions of central necrosis (arrows) within the black-pigmented parenchyma.
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Figure 11a. Lung cancer and coal worker pneumoconiosis in a 68-year-old man who worked for 20 years in a coal mine. (a) Axial CT scan (5.0-mm-thick section) obtained at the level of the left basal truncal bronchus shows a well-defined 2-cm-diameter nodule (arrow) in an upper segment of the lower lobe of the left lung, a finding that represents a combined neuroendocrine large cell carcinoma and adenocarcinoma, as well as multiple smaller nodules (arrowheads). (b) T2-weighted MR image obtained at a level similar to that in b shows the high-signal-intensity nodule (arrow) in the lower lobe. (c) Integrated positron emission tomographic (PET)-CT scan shows a high uptake of fluorine 18 fluorodeoxyglucose (FDG) (arrow) in the nodule, a finding suggestive of malignancy. (d) Photograph of a gross specimen obtained at left lower lobectomy shows the cancer (arrow) and multiple black-pigmented nodules (arrowheads) in the lung parenchyma and pleural surface.
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Figure 11b. Lung cancer and coal worker pneumoconiosis in a 68-year-old man who worked for 20 years in a coal mine. (a) Axial CT scan (5.0-mm-thick section) obtained at the level of the left basal truncal bronchus shows a well-defined 2-cm-diameter nodule (arrow) in an upper segment of the lower lobe of the left lung, a finding that represents a combined neuroendocrine large cell carcinoma and adenocarcinoma, as well as multiple smaller nodules (arrowheads). (b) T2-weighted MR image obtained at a level similar to that in b shows the high-signal-intensity nodule (arrow) in the lower lobe. (c) Integrated positron emission tomographic (PET)-CT scan shows a high uptake of fluorine 18 fluorodeoxyglucose (FDG) (arrow) in the nodule, a finding suggestive of malignancy. (d) Photograph of a gross specimen obtained at left lower lobectomy shows the cancer (arrow) and multiple black-pigmented nodules (arrowheads) in the lung parenchyma and pleural surface.
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Figure 11c. Lung cancer and coal worker pneumoconiosis in a 68-year-old man who worked for 20 years in a coal mine. (a) Axial CT scan (5.0-mm-thick section) obtained at the level of the left basal truncal bronchus shows a well-defined 2-cm-diameter nodule (arrow) in an upper segment of the lower lobe of the left lung, a finding that represents a combined neuroendocrine large cell carcinoma and adenocarcinoma, as well as multiple smaller nodules (arrowheads). (b) T2-weighted MR image obtained at a level similar to that in b shows the high-signal-intensity nodule (arrow) in the lower lobe. (c) Integrated positron emission tomographic (PET)-CT scan shows a high uptake of fluorine 18 fluorodeoxyglucose (FDG) (arrow) in the nodule, a finding suggestive of malignancy. (d) Photograph of a gross specimen obtained at left lower lobectomy shows the cancer (arrow) and multiple black-pigmented nodules (arrowheads) in the lung parenchyma and pleural surface.
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Figure 11d. Lung cancer and coal worker pneumoconiosis in a 68-year-old man who worked for 20 years in a coal mine. (a) Axial CT scan (5.0-mm-thick section) obtained at the level of the left basal truncal bronchus shows a well-defined 2-cm-diameter nodule (arrow) in an upper segment of the lower lobe of the left lung, a finding that represents a combined neuroendocrine large cell carcinoma and adenocarcinoma, as well as multiple smaller nodules (arrowheads). (b) T2-weighted MR image obtained at a level similar to that in b shows the high-signal-intensity nodule (arrow) in the lower lobe. (c) Integrated positron emission tomographic (PET)-CT scan shows a high uptake of fluorine 18 fluorodeoxyglucose (FDG) (arrow) in the nodule, a finding suggestive of malignancy. (d) Photograph of a gross specimen obtained at left lower lobectomy shows the cancer (arrow) and multiple black-pigmented nodules (arrowheads) in the lung parenchyma and pleural surface.
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Figure 12a. Progressive massive fibrosis in a 59-year-old man who worked for 20 years in a coal mine. (a) Composite of axial thin-section CT scans (1.0-mm-thick sections) obtained at various levels of the distal trachea shows irregularly marginated 20–30-mm nodules (arrows) accompanied by smaller satellite nodules and surrounding reticulation in the upper lobe of both lungs. (b) T1-weighted MR image obtained at a level close to that in a shows the slightly hyperintense lesions (arrows) in both upper lobes. (c) T2-weighted MR image obtained at a similar level shows an absence of signal at the lesion sites and a small pleural effusion (arrowheads) in the right lung. (d) Integrated PET-CT scan shows increased uptake of FDG in both nodules (straight arrows) and in a right paratracheal lymph node (curved arrow).
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Figure 12b. Progressive massive fibrosis in a 59-year-old man who worked for 20 years in a coal mine. (a) Composite of axial thin-section CT scans (1.0-mm-thick sections) obtained at various levels of the distal trachea shows irregularly marginated 20–30-mm nodules (arrows) accompanied by smaller satellite nodules and surrounding reticulation in the upper lobe of both lungs. (b) T1-weighted MR image obtained at a level close to that in a shows the slightly hyperintense lesions (arrows) in both upper lobes. (c) T2-weighted MR image obtained at a similar level shows an absence of signal at the lesion sites and a small pleural effusion (arrowheads) in the right lung. (d) Integrated PET-CT scan shows increased uptake of FDG in both nodules (straight arrows) and in a right paratracheal lymph node (curved arrow).
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Figure 12c. Progressive massive fibrosis in a 59-year-old man who worked for 20 years in a coal mine. (a) Composite of axial thin-section CT scans (1.0-mm-thick sections) obtained at various levels of the distal trachea shows irregularly marginated 20–30-mm nodules (arrows) accompanied by smaller satellite nodules and surrounding reticulation in the upper lobe of both lungs. (b) T1-weighted MR image obtained at a level close to that in a shows the slightly hyperintense lesions (arrows) in both upper lobes. (c) T2-weighted MR image obtained at a similar level shows an absence of signal at the lesion sites and a small pleural effusion (arrowheads) in the right lung. (d) Integrated PET-CT scan shows increased uptake of FDG in both nodules (straight arrows) and in a right paratracheal lymph node (curved arrow).
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Figure 12d. Progressive massive fibrosis in a 59-year-old man who worked for 20 years in a coal mine. (a) Composite of axial thin-section CT scans (1.0-mm-thick sections) obtained at various levels of the distal trachea shows irregularly marginated 20–30-mm nodules (arrows) accompanied by smaller satellite nodules and surrounding reticulation in the upper lobe of both lungs. (b) T1-weighted MR image obtained at a level close to that in a shows the slightly hyperintense lesions (arrows) in both upper lobes. (c) T2-weighted MR image obtained at a similar level shows an absence of signal at the lesion sites and a small pleural effusion (arrowheads) in the right lung. (d) Integrated PET-CT scan shows increased uptake of FDG in both nodules (straight arrows) and in a right paratracheal lymph node (curved arrow).
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Figure 13. Asbestos body. Photomicrograph (original magnification, x1000; hematoxylin-eosin stain) shows a translucent asbestos fiber (straight arrow) surrounded by a segmented protein-iron coat that is much more prominent around the lower part of the fiber, and an alveolar macrophage (curved arrow).
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Figure 14. Asbestosis in a 58-year-old man who worked for 25 years in building construction. Chest radiograph shows small reticular opacities (arrows) at the costophrenic sulcus in the lower zone of both lungs.
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Figure 15a. Asbestosis in a 59-year-old man who worked for 30 years at an automobile factory. (a) Axial thin-section CT scan (1.5-mm-thick section) obtained at the level of the liver dome with the patient prone shows small subpleural nodules (straight arrows), patchy ground-glass opacities (curved arrows), and interlobular septal thickening (arrowhead) suggestive of early-stage asbestosis. (b) CT scan obtained with mediastinal window settings at the level of the suprahepatic inferior vena cava shows bandlike pleural thickening (arrowheads) in the lower lobe of both lungs, a finding indicative of pleural plaque. (c) Photomicrograph (original magnification, x12; hematoxylin-eosin stain) of a pathologic specimen obtained with video-assisted thoracoscopic surgical biopsy depicts subpleural and septal fibrous thickening (arrows).
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Figure 15b. Asbestosis in a 59-year-old man who worked for 30 years at an automobile factory. (a) Axial thin-section CT scan (1.5-mm-thick section) obtained at the level of the liver dome with the patient prone shows small subpleural nodules (straight arrows), patchy ground-glass opacities (curved arrows), and interlobular septal thickening (arrowhead) suggestive of early-stage asbestosis. (b) CT scan obtained with mediastinal window settings at the level of the suprahepatic inferior vena cava shows bandlike pleural thickening (arrowheads) in the lower lobe of both lungs, a finding indicative of pleural plaque. (c) Photomicrograph (original magnification, x12; hematoxylin-eosin stain) of a pathologic specimen obtained with video-assisted thoracoscopic surgical biopsy depicts subpleural and septal fibrous thickening (arrows).
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Figure 15c. Asbestosis in a 59-year-old man who worked for 30 years at an automobile factory. (a) Axial thin-section CT scan (1.5-mm-thick section) obtained at the level of the liver dome with the patient prone shows small subpleural nodules (straight arrows), patchy ground-glass opacities (curved arrows), and interlobular septal thickening (arrowhead) suggestive of early-stage asbestosis. (b) CT scan obtained with mediastinal window settings at the level of the suprahepatic inferior vena cava shows bandlike pleural thickening (arrowheads) in the lower lobe of both lungs, a finding indicative of pleural plaque. (c) Photomicrograph (original magnification, x12; hematoxylin-eosin stain) of a pathologic specimen obtained with video-assisted thoracoscopic surgical biopsy depicts subpleural and septal fibrous thickening (arrows).
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Figure 16a. Asbestosis in a 70-year-old man who worked for 30 years in a shipyard. (a, b) Axial thin-section CT scans (1.0-mm-thick sections) at the level of the suprahepatic inferior vena cava. (a) Scan obtained with lung window settings shows subpleural consolidation (arrow) in the lower lobe of the left lung, with reticulation, ground-glass opacities, and honeycombing. (b) Scan obtained with mediastinal window settings shows subpleural consolidation (arrow), pleural thickening (arrowheads) and effusion. (c, d) Photomicrographs of pathologic specimens obtained with video-assisted thoracic surgical biopsy. (c) Low-power micrograph (original magnification, x40; hematoxylin-eosin stain) shows dense collagen fibers in the pleura (arrows). (d) High-power micrograph (original magnification, x200; iron stain) shows asbestos bodies in the parenchyma (arrows).
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Figure 16b. Asbestosis in a 70-year-old man who worked for 30 years in a shipyard. (a, b) Axial thin-section CT scans (1.0-mm-thick sections) at the level of the suprahepatic inferior vena cava. (a) Scan obtained with lung window settings shows subpleural consolidation (arrow) in the lower lobe of the left lung, with reticulation, ground-glass opacities, and honeycombing. (b) Scan obtained with mediastinal window settings shows subpleural consolidation (arrow), pleural thickening (arrowheads) and effusion. (c, d) Photomicrographs of pathologic specimens obtained with video-assisted thoracic surgical biopsy. (c) Low-power micrograph (original magnification, x40; hematoxylin-eosin stain) shows dense collagen fibers in the pleura (arrows). (d) High-power micrograph (original magnification, x200; iron stain) shows asbestos bodies in the parenchyma (arrows).
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Figure 16c. Asbestosis in a 70-year-old man who worked for 30 years in a shipyard. (a, b) Axial thin-section CT scans (1.0-mm-thick sections) at the level of the suprahepatic inferior vena cava. (a) Scan obtained with lung window settings shows subpleural consolidation (arrow) in the lower lobe of the left lung, with reticulation, ground-glass opacities, and honeycombing. (b) Scan obtained with mediastinal window settings shows subpleural consolidation (arrow), pleural thickening (arrowheads) and effusion. (c, d) Photomicrographs of pathologic specimens obtained with video-assisted thoracic surgical biopsy. (c) Low-power micrograph (original magnification, x40; hematoxylin-eosin stain) shows dense collagen fibers in the pleura (arrows). (d) High-power micrograph (original magnification, x200; iron stain) shows asbestos bodies in the parenchyma (arrows).
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Figure 16d. Asbestosis in a 70-year-old man who worked for 30 years in a shipyard. (a, b) Axial thin-section CT scans (1.0-mm-thick sections) at the level of the suprahepatic inferior vena cava. (a) Scan obtained with lung window settings shows subpleural consolidation (arrow) in the lower lobe of the left lung, with reticulation, ground-glass opacities, and honeycombing. (b) Scan obtained with mediastinal window settings shows subpleural consolidation (arrow), pleural thickening (arrowheads) and effusion. (c, d) Photomicrographs of pathologic specimens obtained with video-assisted thoracic surgical biopsy. (c) Low-power micrograph (original magnification, x40; hematoxylin-eosin stain) shows dense collagen fibers in the pleura (arrows). (d) High-power micrograph (original magnification, x200; iron stain) shows asbestos bodies in the parenchyma (arrows).
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Figure 17a. Berylliosis in a 49-year-old man who worked for 7 years in metal polishing. (a) Chest radiograph shows bilateral mediastinal and hilar lymph node enlargement, as well as internal fixation of a right clavicular fracture. (b, c) Axial thin-section CT scans (1.0-mm-thick-sections) obtained at the levels of the bronchus intermedius (b) and the basal segmental bronchus (c) show multiple small nodules along the bronchovascular bundles (straight arrows) and in subfissural regions (arrowheads) and enlarged hilar lymph nodes (curved arrows). (d) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a pathologic specimen obtained with mediastinoscopic lymph node biopsy shows multiple noncaseating granulomas (arrows).
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Figure 17b. Berylliosis in a 49-year-old man who worked for 7 years in metal polishing. (a) Chest radiograph shows bilateral mediastinal and hilar lymph node enlargement, as well as internal fixation of a right clavicular fracture. (b, c) Axial thin-section CT scans (1.0-mm-thick-sections) obtained at the levels of the bronchus intermedius (b) and the basal segmental bronchus (c) show multiple small nodules along the bronchovascular bundles (straight arrows) and in subfissural regions (arrowheads) and enlarged hilar lymph nodes (curved arrows). (d) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a pathologic specimen obtained with mediastinoscopic lymph node biopsy shows multiple noncaseating granulomas (arrows).
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Figure 17c. Berylliosis in a 49-year-old man who worked for 7 years in metal polishing. (a) Chest radiograph shows bilateral mediastinal and hilar lymph node enlargement, as well as internal fixation of a right clavicular fracture. (b, c) Axial thin-section CT scans (1.0-mm-thick-sections) obtained at the levels of the bronchus intermedius (b) and the basal segmental bronchus (c) show multiple small nodules along the bronchovascular bundles (straight arrows) and in subfissural regions (arrowheads) and enlarged hilar lymph nodes (curved arrows). (d) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a pathologic specimen obtained with mediastinoscopic lymph node biopsy shows multiple noncaseating granulomas (arrows).
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Figure 17d. Berylliosis in a 49-year-old man who worked for 7 years in metal polishing. (a) Chest radiograph shows bilateral mediastinal and hilar lymph node enlargement, as well as internal fixation of a right clavicular fracture. (b, c) Axial thin-section CT scans (1.0-mm-thick-sections) obtained at the levels of the bronchus intermedius (b) and the basal segmental bronchus (c) show multiple small nodules along the bronchovascular bundles (straight arrows) and in subfissural regions (arrowheads) and enlarged hilar lymph nodes (curved arrows). (d) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a pathologic specimen obtained with mediastinoscopic lymph node biopsy shows multiple noncaseating granulomas (arrows).
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Figure 18a. Giant cell interstitial pneumonia in a 47-year-old man who worked for 13 years as an iron driller. (a) Chest radiograph shows multiple ill-defined small nodules and reticular opacities in the upper and middle zones of both lungs. (b) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the liver dome shows bilateral patchy subpleural ground-glass opacities (arrows) and reticulation. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a pathologic specimen obtained with video-assisted thoracoscopic surgical biopsy in the lower lobe of the right lung shows intraalveolar macrophages with occasional giant cells (arrows).
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Figure 18b. Giant cell interstitial pneumonia in a 47-year-old man who worked for 13 years as an iron driller. (a) Chest radiograph shows multiple ill-defined small nodules and reticular opacities in the upper and middle zones of both lungs. (b) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the liver dome shows bilateral patchy subpleural ground-glass opacities (arrows) and reticulation. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a pathologic specimen obtained with video-assisted thoracoscopic surgical biopsy in the lower lobe of the right lung shows intraalveolar macrophages with occasional giant cells (arrows).
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Figure 18c. Giant cell interstitial pneumonia in a 47-year-old man who worked for 13 years as an iron driller. (a) Chest radiograph shows multiple ill-defined small nodules and reticular opacities in the upper and middle zones of both lungs. (b) Axial thin-section CT scan (1.0-mm-thick section) obtained at the level of the liver dome shows bilateral patchy subpleural ground-glass opacities (arrows) and reticulation. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a pathologic specimen obtained with video-assisted thoracoscopic surgical biopsy in the lower lobe of the right lung shows intraalveolar macrophages with occasional giant cells (arrows).
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Figure 19. Talcosis in a 52-year-old man who worked for 8 years in magnesium silicate processing. Axial thin-section CT scan (1.5-mm-thick section) obtained at the level of the main bronchi shows dense consolidation, with dilated bronchi, pericicatricial emphysematous changes (arrows), ground-glass opacities, and interlobular septal thickening (arrowheads) in the upper lobe of both lungs. (Courtesy of Nestor Müller, MD, PhD, Vancouver Hospital and Health Sciences Center, Vancouver, Canada.)
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Figure 20. Siderosis in a 49-year-old man who worked for 8 years in a shipyard. Thin-section CT scan (1.5-mm-thick section) obtained at the level of the aortic arch shows multiple small and poorly defined centrilobular nodules (arrows) in the upper lobe of both lungs. (Courtesy of Yeon Joo Jeong, MD, Pusan National University Hospital, Pusan, Korea.)
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Copyright © 2006 by the Radiological Society of North America.
