DOCSLIB.ORG

European Respiratory Society Classification of the Idiopathic

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
European Respiratory Society Classification of the Idiopathic This copy is for personal use only. To order printed copies, contact [email protected] 1849 CHEST IMAGING American Thoracic Society– European Respiratory Society Classification of the Idiopathic Interstitial Pneumonias: Advances in Knowledge since 20021 Nicola Sverzellati, MD, PhD David A. Lynch, MB In the updated American Thoracic Society–European Respira- David M. Hansell, MD, FRCP, FRCR tory Society classification of the idiopathic interstitial pneumonias Takeshi Johkoh, MD, PhD (IIPs), the major entities have been preserved and grouped into Talmadge E. King, Jr, MD (a) “chronic fibrosing IIPs” (idiopathic pulmonary fibrosis and id- William D. Travis, MD iopathic nonspecific interstitial pneumonia), (b) “smoking-related IIPs” (respiratory bronchiolitis–associated interstitial lung disease Abbreviations: H-E = hematoxylin-eosin, and desquamative interstitial pneumonia), (c) “acute or subacute IIP = idiopathic interstitial pneumonia, IPF = IIPs” (cryptogenic organizing pneumonia and acute interstitial idiopathic pulmonary fibrosis, NSIP = nonspe- cific interstitial pneumonia, RB-ILD = respi- pneumonia), and (d) “rare IIPs” (lymphoid interstitial pneumonia ratory bronchiolitis–associated interstitial lung and idiopathic pleuroparenchymal fibroelastosis). Furthermore, it disease, UIP = usual interstitial pneumonia has been acknowledged that a final diagnosis is not always achiev- RadioGraphics 2015; 35:1849–1872 able, and the category “unclassifiable IIP” has been proposed. The Published online 10.1148/rg.2015140334 diagnostic interpretation of the IIPs is often challenging because Content Codes: other diseases with a known etiology (most notably, connective tis- 1From the Section of Diagnostic Imaging, Depart- sue disease and hypersensitivity pneumonitis) may show similar ment of Surgical Sciences, University of Parma, morphologic patterns. Indeed, more emphasis has been given to the Via Gramsci 14, 43100 Parma, Italy (N.S.); De- partment of Radiology, National Jewish Health, integration of clinical, computed tomographic (CT), and patholog- Denver, Colo (D.A.L.); Department of Radiol- ic findings for multidisciplinary diagnosis. Typical CT-based mor- ogy, Royal Brompton Hospital, London, England (D.M.H.); Department of Radiology, Kinki Cen- phologic patterns are associated with the IIPs, and radiologists play tral Hospital of Mutual Aid Association of Public an important role in diagnosis and characterization. Optimal CT School Teachers, Hyogo, Japan (T.J.); Depart- quality and a systematic approach are both pivotal for evaluation of ment of Medicine, University of California–San Francisco, San Francisco, Calif (T.E.K.); and IIP. Interobserver variation for the various patterns encountered in Department of Pathology, Memorial Sloan Ket- the IIPs is an issue. It is important for radiologists to understand tering Cancer Center, New York, NY (W.D.T.). Received December 9, 2014; revision requested the longitudinal behavior of IIPs at serial CT examinations, espe- January 22, 2015, and received February 12; ac- cially for providing a framework for cases that are unclassifiable or cepted February 17. For this journal-based SA- in which a histologic diagnosis cannot be obtained. CME activity, the authors D.A.L. and D.M.H. have provided disclosures (see p 1868); all other ©RSNA, 2015฀•฀radiographics.rsna.org authors, the editor, and reviewers have disclosed no relevant relationships. Address correspon- dence to N.S. (e-mail: [email protected]). See discussion on this article by McLoud (pp 1871–1872). Introduction ©RSNA, 2015 The American Thoracic Society–European Respiratory Society clas- sification of the idiopathic interstitial pneumonias (IIPs) underwent SA-CME LEARNING OBJECTIVES revision in 2013 (1). This update was not designed as a stand-alone After completing this journal-based SA-CME document but as a supplement to the previous 2002 IIP classifica- activity, participants will be able to: tion, which defined key individual diseases and the best diagnostic ■ Explain optimal-quality CT requirements approach to them (2). Pathologic patterns previously formed the basis for the evaluation of patients with IIP. for the classification of IIP subtypes, whereas in the update, more em- ■ Distinguish fibrotic from nonfibrotic CT phasis is given to the integration of clinical, computed tomographic features of the IIPs. (CT), and pathologic findings for multidisciplinary diagnosis (1). ■ Describe various longitudinal CT changes that may be seen in patients with any IIP. See www.rsna.org/education/search/RG. 1850 November-December 2015 radiographics.rsna.org cases that are unclassifiable or in which a histo- TEACHING POINTS logic diagnosis cannot be obtained (Table 2) (1). ■ A systematic approach to CT of the chest in subjects suspect- Importantly, imaging will play an ever-increasing ed of having IIP entails the evaluation of image quality, the role in monitoring IIP and in refining the diag- precise description of specific disease features with standard terminology, and the determination of the distribution of dis- nosis of chronic fibrosing lung diseases as their ease in the axial and craniocaudal planes. The most important disease behavior becomes evident. next step is to determine whether the CT features permit a The authors of the updated IIP classification high-confidence diagnosis of UIP. In cases that do not meet document reviewed MEDLINE publications strict criteria for UIP, the presence of traction bronchiectasis, relevant to key imaging questions for the years architectural distortion, or volume loss usually permits distinc- tion of fibrosing from nonfibrosing interstitial pneumonia. 2001–2011. However, there was inadequate ■ Terms such as UIP pattern and NSIP pattern are helpful in dem- space in the document to address several im- onstrating that one is discussing the radiologic pattern rather portant imaging-related issues, for example, the than the associated clinical-pathologic syndrome. Indeed, it is key CT principles for the evaluation of IIP, the important to appreciate that the CT patterns, especially those fundamental CT features of each entity, and the of the chronic fibrosing IIPs, may encompass several clinical- longitudinal behavior of these features. The pur- radiologic-pathologic entities; for example, NSIP and UIP pat- terns may be found in hypersensitivity pneumonitis and in pose of this review article is to expand the lit- association with connective tissue diseases. erature search through June 2014, concentrating ■ The primary role of CT is to separate chronic fibrosing lung on the CT aspects of IIP that were not covered diseases with a UIP pattern from those with non-UIP lesions, in depth in the 2013 classification but are nev- including those with findings associated with other IIPs (eg, ertheless important to radiologists tasked with RB-ILD, lymphoid interstitial pneumonia, and idiopathic pleu- tackling this difficult group of disorders. First, roparenchymal fibroelastosis). the principles of radiologic IIP assessment are ■ CT appearances of idiopathic pleuroparenchymal fibroelasto- reviewed. Then the four IIP groups are covered: sis are distinctive, with irregular pleural thickening and “tags” in the upper zones that merge with fibrotic changes in the (a) chronic fibrosing IIPs, (b) smoking-related subjacent lung, associated with evidence of substantial upper IIPs, (c) acute or subacute IIPs, and (d) rare lobe volume loss (architectural distortion, traction bronchiec- IIPs. Finally, the category of unclassifiable IIP is tasis, and hilar elevation). discussed. ■ The 2013 IIP consensus statement acknowledges, as did the 2002 consensus statement, that a final diagnosis is not always Key Principles for achievable. Radiologic Assessment of IIP CT is pivotal for the evaluation of IIP. Optimal- quality CT requires the use of thin-section (,2- In the updated classification, the major entities mm) reconstruction and high-spatial-resolution have been preserved and grouped into (a) “chronic reconstruction. Images should be obtained dur- fibrosing IIPs” (idiopathic pulmonary fibrosis [IPF] ing a full inspiration to total lung capacity (3). and idiopathic nonspecific interstitial pneumonia Despite the risk of increasing the radiation dose [NSIP]), (b) “smoking-related IIPs” (respira- delivered to patients, volumetric CT acquisition tory bronchiolitis–associated interstitial lung with multidetector CT is generally preferred to disease [RB-ILD] and desquamative interstitial noncontiguous imaging (4). Importantly, volu- pneumonia), and (c) “acute or subacute IIPs” metric CT acquisition and derived multiplanar (cryptogenic organizing pneumonia and acute reconstructions (a) allow improved character- interstitial pneumonia). In addition, idiopathic ization of patchy disease; (b) allow better delin- pleuroparenchymal fibroelastosis has been newly eation of disease extent; (c) simplify analysis of included and classified together with lymphoid disease distribution (5); (d) allow identification interstitial pneumonia in a fourth group, “rare of ancillary findings such as nodules or bron- IIPs” (Table 1). In the updated classification, chiectasis; (e) facilitate differentiation between it has again been acknowledged that in a sub- honeycombing and traction bronchiectasis, set of cases, a final diagnosis cannot always be which may be crucial to diagnose the UIP pat- achieved despite extensive multidisciplinary dis- tern, as shown in Figures 1 and 2 (6); and (f) cussion, and such cases are considered “unclas- optimize follow-up CT matching for any com- sifiable”
Load more

Recommended publications
  • Occupational Airborne Particulates
    Environmental Burden of Disease Series, No. 7 Occupational airborne particulates Assessing the environmental burden of disease at national and local levels Tim Driscoll Kyle Steenland Deborah Imel Nelson James Leigh Series Editors Annette Prüss-Üstün, Diarmid Campbell-Lendrum, Carlos Corvalán, Alistair Woodward World Health Organization Protection of the Human Environment Geneva 2004 WHO Library Cataloguing-in-Publication Data Occupational airborne particulates : assessing the environmental burden of disease at national and local levels / Tim Driscoll … [et al.]. (Environmental burden of disease series / series editors: Annette Prüss-Ustun ... [et al.] ; no. 7) 1.Dust - adverse effects 2.Occupational exposure 3.Asthma - chemically induced 4.Pulmonary disease, Chronic obstructive - chemically induced 5.Pneumoconiosis - etiology 6.Cost of illness 7.Epidemiologic studies 8.Risk assessment - methods 9.Manuals I.Driscoll, Tim. II.Prüss-Üstün, Annette. III.Series. ISBN 92 4 159186 2 (NLM classification: WA 450) ISSN 1728-1652 Suggested Citation Tim Driscoll, et al. Occupational airborne particulates: assessing the environmental burden of disease at national and local levels. Geneva, World Health Organization, 2004. (Environmental Burden of Disease Series, No. 7). © World Health Organization 2004 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]).
    [Show full text]
  • Pneumoconiosis
    Prim Care Respir J 2013; 22(2): 249-252 PERSPECTIVE Pneumoconiosis *Paul Cullinan1, Peter Reid2 1 Consultant Physician, Royal Brompton and Harefield NHS Foundation Trust, London, UK 2 Consultant Physician, Western General Hospital, Edinburgh, UK Introduction Figure 1. Asbestosis; the HRCT scan shows the typical The pneumoconioses are parenchymal lung diseases that arise from picture of subpleural fibrosis (solid arrow); in addition inhalation of (usually) inorganic dusts at work. Some such dusts are there is diffuse, left-sided pleural thickening (broken biologically inert but visible on a chest X-ray or CT scan; thus, while arrow), characteristic too of heavy asbestos exposure they are radiologically alarming they do not give rise to either clinical disease or deficits in pulmonary function. Others – notably asbestos and crystalline silica – are fibrogenic so that the damage they cause is through the fibrosis induced by the inhaled dust rather than the dust itself. Classically these give rise to characteristic radiological patterns and restrictive deficits in lung function with reductions in diffusion capacity; importantly, they may progress long after exposure to the causative mineral has finished. In the UK and similar countries asbestosis is the commonest form of pneumoconiosis but in less developed parts of the world asbestosis is less frequent than silicosis; these two types are discussed in detail below. Other, rarer types of pneumoconiosis include stannosis (from tin fume), siderosis (iron), berylliosis (beryllium), hard metal disease (cobalt) and coal worker’s pneumoconiosis. Asbestosis Clinical scenario How is the diagnosis made? Asbestosis is the ‘pneumoconiosis’ that arises from exposure to A man of 78 reports gradually worsening breathlessness; he has asbestos in the workplace.1 The diagnosis is made when, on the no relevant medical history of note and has never been a regular background of heavy occupational exposure to any type of asbestos, smoker.
    [Show full text]
  • Pneumoconiosis in Coalminers
    6I8 POSTGRADUATE MEDICAL JOURNAL December I949 Postgrad Med J: first published as 10.1136/pgmj.25.290.618 on 1 December 1949. Downloaded from IRVINE, L. G., SIMSON, F. W., and STRACHAN, A. S. (1930), NEW YORK STATE DEPARTMENT OF LABOUR (1949), Proc. Intern. Conf. on Silicosis in Johannesburg, I.L.O. Studies Monthly Review, 28, No. 4, April. and Reports, Series F. (Industrial Hygiene), No. I3, p. 259. PERRY, K. M. A. (1948), Proc. Ninth Intern. Cong. of Ind. Med., JONES, W. R. (I933), ,. of Hyg., 33, 307. London (in the press). KETTLE, E. H. (I932), Y. Path. and Bat., 35, 395. KETTLE, E. H. (I934), Ibid., 38, 20o. POLICARD, A. (1947), Proc. Conf. of the Institution of Mining KING, E. J. (I945), M.R.C. Special Report Series, No. 250, p. 73. Engineers and Institution of Mining and Metalurgy, London, KING, E. J. (I947) Occ. Med., 4, 26. P. 24. KING, E. J., WRI6HT, B. M., and RAY, S. C. (I949), Paper read ROGERS, E. (i944), Paper read to the British Tuberculosis Associa- to the Path. Soc., Great Britain, January, 1949. tion. McLAUGHLIN, A. I. G., ROGERS, E., and DUNHAM, K. C. (I949), Brit. 3Y. Ind. Med., 6, I84. SHAVER, C. G. (1948), Radiology, 50, 760. MINERS' PHTHISIS MEDICAL BUREAU OF SOUTH SHAVER, C. G., and RIDDELL, A. R. (I947), J. Id. Hyg. and AFRICA (1946), Report for the Three Years ending Jy 31, Tox., 29, 145. I944 (South African Government Printer). VORWALD, A. J., and CARR, J. W. (1938), Amer. J7. Path., 14,49. PNEUMOCONIOSIS IN COAL MINERS By J.
    [Show full text]
  • Progressive Plasterer's Pneumoconiosis Complicated By
    Kurosaki et al. BMC Pulmonary Medicine (2019) 19:6 https://doi.org/10.1186/s12890-018-0776-4 CASEREPORT Open Access Progressive plasterer’s pneumoconiosis complicated by fibrotic interstitial pneumonia: a case report Fumio Kurosaki1,2*, Tamiko Takemura3, Masashi Bando1, Tomonori Kuroki1,2, Toshio Numao2, Hiroshi Moriyama4 and Koichi Hagiwara1 Abstract Background: Although the prevalence of pneumoconiosis has been decreasing due to improvements in working conditions and regular health examinations, occupational hygiene measures are still being established. Plasterers encounter a number of hazardous materials that may be inhaled in the absence of sufficient protection. Case presentation: A 64-year-old man who plastered without any dust protection for more than 40 years was referred to our hospital with suspected interstitial pneumonia. Mixed dust pneumoconiosis and an unusual interstitial pneumonia (UIP) pattern with fibroblastic foci were diagnosed by video-assisted thoracoscopic surgery, and an elemental analysis detected elements included in plaster work materials. Despite the cessation of plaster work and administration of nintedanib, the patient developed advanced respiratory failure. Conclusion: Plasterers are at an increased risk of pneumoconiosis and may have a poor prognosis when complicated by the UIP pattern. Thorough dust protection and careful monitoring are needed. Keywords: Plasterer, Pneumoconiosis, Usual interstitial pneumonia, Elemental analysis Background unusual interstitial pneumonia (UIP) pattern, the cause of With energy transition from coal to oil and nuclear power, which was identified as plaster work by an elemental coal mines completely disappeared by the early first analysis. Therefore, plasterers need to take proper coun- decade of the 2000s in Japan. Furthermore, improvements termeasures for dust prevention and undergo regular in industrial hygiene and vocational education have examinations.
    [Show full text]
  • Differential Diagnosis of Granulomatous Lung Disease: Clues and Pitfalls
    SERIES PATHOLOGY FOR THE CLINICIAN Differential diagnosis of granulomatous lung disease: clues and pitfalls Shinichiro Ohshimo1, Josune Guzman2, Ulrich Costabel3 and Francesco Bonella3 Number 4 in the Series “Pathology for the clinician” Edited by Peter Dorfmüller and Alberto Cavazza Affiliations: 1Dept of Emergency and Critical Care Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. 2General and Experimental Pathology, Ruhr-University Bochum, Bochum, Germany. 3Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany. Correspondence: Francesco Bonella, Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University of Duisburg-Essen, Tueschener Weg 40, 45239 Essen, Germany. E-mail: [email protected] @ERSpublications A multidisciplinary approach is crucial for the accurate differential diagnosis of granulomatous lung diseases http://ow.ly/FxsP30cebtf Cite this article as: Ohshimo S, Guzman J, Costabel U, et al. Differential diagnosis of granulomatous lung disease: clues and pitfalls. Eur Respir Rev 2017; 26: 170012 [https://doi.org/10.1183/16000617.0012-2017]. ABSTRACT Granulomatous lung diseases are a heterogeneous group of disorders that have a wide spectrum of pathologies with variable clinical manifestations and outcomes. Precise clinical evaluation, laboratory testing, pulmonary function testing, radiological imaging including high-resolution computed tomography and often histopathological assessment contribute to make
    [Show full text]
  • Misclassification of Occupational Disease in Lung Transplant Recipients
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author J Heart Manuscript Author Lung Transplant Manuscript Author . Author manuscript; available in PMC 2017 November 13. Published in final edited form as: J Heart Lung Transplant. 2017 May ; 36(5): 588–590. doi:10.1016/j.healun.2017.02.021. Misclassification of occupational disease in lung transplant recipients David J. Blackley, DrPHa, Cara N. Halldin, PhDa, Robert A. Cohen, MDa,b, Kristin J. Cummings, MDa, Eileen Storey, MDa, and A. Scott Laney, PhDa aRespiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA bSchool of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA Data from the United States Organ Procurement and Transplantation Network (OPTN) registry have been analyzed in recent years to assess post–lung transplant (LT) survival in occupational lung disease patients.1–3 Registry data include diagnosis codes with limited specificity; each patient is assigned a diagnosis code at waitlist candidacy, at listing, and at LT, and these codes can differ. The use of both numeric and free-text data can produce incompatible or unlikely diagnosis code pairings (such as a numeric code for idiopathic pulmonary fibrosis with a paired free-text entry of “silicosis”). The resulting misclassification could bias findings related to patient characteristics, post-LT survival comparisons and other measures used to summarize outcomes. Diagnosis codes from OPTN data could be inadequate for case finding and may result in missed occupational lung disease cases. Our objective was to identify and describe adult LT recipients documented as having conditions known to be entirely attributable to occupational exposure, and to calculate the proportion of those patients who were assigned an occupational lung disease diagnosis code at LT.
    [Show full text]
  • BERYLLIUM DISEASE by I
    Postgrad Med J: first published as 10.1136/pgmj.34.391.262 on 1 May 1958. Downloaded from 262 BERYLLIUM DISEASE By I. B. SNEDDON, M.B., Ch.B., F.R.C.P. Consultant Dermatologist, Rupert Hallam Department of Dermatology, Sheffield It is opportune in a symposium on sarcoidosis monary berylliosis which fulfilled the most to discuss beryllium disease because it mimics so stringent diagnostic criteria. closely the naturally occurring Boecks sarcoid and A beryllium case registry set up at the Massa- yet carries a far graver prognosis. chusetts General Hospital by Dr. Harriet Hardy Beryllium was first reported to possess toxic had collected by 1956 309 examples of the disease, properties by Weber and Englehardt (I933) in of whom 84 had died. The constant finding of Germany. They described bronchitis and acute beryllium in autopsy material from the fatal cases respiratory disease in workers extracting beryllium had proved beyond doubt the association between from ore. Similar observations were made by the granulomatous reaction and the metal. Marradi Fabroni (I935) in Italy and Gelman It is difficult to reconcile the paucity of accounts (I936) in Russia. Further reports came from of beryllium disease in this country with the large Germany in I942 where beryllium poisoning was amount of beryllium compounds which have been recognized as a compensatable disease. Towards used in the last ten The in the end of World War II the production and use years. only reports the medical literature are those of Agate (I948),copyright. of beryllium salts increased greatly in the United Sneddon (i955), and Rogers (1957), but several States, and in 1943 Van Ordstrand et al.
    [Show full text]
  • A Breathless Builder
    case presentations no03.qxd 17/05/2007 15:38 Page 2 CASE PRESENTATION A breathless builder J.J. Lyons1 P.J. Sime1 Case report hand-grinder, a common task known as "tuck- D. Ward2 The patient was a 30-year-old male mason whose pointing" (figure 2), while intermittently using a T. Watson3 work frequently involved cutting and grinding disposable particle mask. After completing this J.L. Abraham4 brick and cement with powered tools. He was an job, he felt well for ~2 months and then gradu- R. Evans5 active smoker (1–1.5 packs per day). He had ally began to develop a nonproductive cough, 6 M. Budev worked in building construction since the age of dyspnoea on exertion and an 11 kg weight loss K. Costas3 W.S. Beckett1 14 yrs, as a labourer then as a mason and had without fever. Serial pulmonary function testing been a mason for the previous 13 years. He showed restriction and a marked reduction in dif- reported frequent exposure to cement and brick fusing capacity. Chest computed tomography 1Division of Pulmonary and dust while removing stone floors with a jackham- (CT) showed bilateral diffuse infiltrates. A purified Critical Care Medicine, 2Dept of mer. From 8–2 months prior to presentation, he protein derivative test was negative. Anesthesiology and Biomedical had been employed repairing exterior brick on Bronchoalveolar lavage fluid was mucoid, and 3 Engineering and Division of three large apartment buildings (figure 1). This culture was negative. A transbronchial biopsy Thoracic/Foregut Surgery, University of Rochester, Rochester, required cutting through brick and mortar with a was nondiagnostic and the post-bronchoscopy 4Dept of Pathology, SUNY Upstate powered, high-speed demolition saw and grind- chest film showed a very small right apical pneu- Medical University, Syracuse, ing mortar from between bricks with a powered mothorax.
    [Show full text]
  • Occupational Lung Disease - American Lung Association Site
    Lung Disease Data at a Glance: Occupational Lung Disease - American Lung Association site Sick Building Syndrome Racial Disparity Prevention: Monitor Safety and Recognize Breathing Hazards Changing the Face of Occupational Lung Disease Research ● Occupational lung disease is the number-one cause of work-related illness in the United States in terms of frequency, severity and preventability. ● Worldwide, about 20 percent to 30 percent of the male and five percent to 20 percent of the female working-age population may have been exposed to agents that cause cancer in the lungs during their working lives. ● Occupational asthma is the most prevalent occupational lung disease in the United States. Approximately 15 percent of asthma cases in the United States are due to occupational exposures. ● The cost of occupational injuries and illnesses in the United States totals more than $170 billion. In 2002, there were about 294,500 newly reported cases of occupational illness in private industry. ● A total of 2,591 work-related respiratory illnesses with days away from work (2.4 per 100,000 workers) occurred in private workplaces in 2000. The highest total for days away from work due to respiratory illnesses was in the manufacturing sector. ● In 2002, African Americans made up 18.8 percent of the 800,000 textile workers. Exposure to dusts generated while processing cotton can cause byssinosis, a chronic condition that results in blocked airways and impaired lung function. Between 1990 and 1999, African-American males had an age-adjusted mortality rate due to byssinosis that was 80 percent greater than White males. ● It is estimated that African Americans accounted for 20.7 percent of the 3.1 million cleaning and building service jobs, which involve exposure to noxious chemicals and biological contaminants.
    [Show full text]
  • Pneumoconiosis and Byssinosis
    British Journal of Industrial Medicine, 1974, 31, 322-328 Br J Ind Med: first published as 10.1136/oem.31.4.322 on 1 October 1974. Downloaded from Notes and miscellanea Pneumoconiosis and byssinosis D. C. F. MUIR Institute of Occupational Medicine, Roxburgh Place, Edinburgh, EH8 9SU On 1 August 1968 the Minister of Social Security loggerheads over the question of pneumoconiosis in referred the following question to the Industrial general and of related disability in particular. Injuries Advisory Council for consideration and The less controversial aspects of the report should advice: perhaps be mentioned first in order to clear the way Whether in the light of experience and current for a review of its more fundamental features. It is knowledge any adjustment should be made in the well written and has concise and clear explanations terms of the definition of pneumoconiosis in of the problems considered. The historical back- section 58 (3) of the National Insurance (In- ground is reviewed in detail, and there is an excellent copyright. dustrial Injuries) Act 1965; and whether any and, description of the work of the Pneumoconiosis if so, what special provision should be made for Medical Panels. There is a great deal of information disablement due to other respiratory conditions in the report which is not available in textbooks of found in the presence of such pneumoconiosis to occupational medicine, and it should be essential be taken into account in assessing the extent of reading for all who have an interest in this field. The disablement due to the disease. summary and conclusions are short and explicit.
    [Show full text]
  • Original Article
    Artigo Original Broncoscopia no diagnóstico de tuberculose pulmonar em pacientes com baciloscopia de escarro negativa* Bronchoscopy for the diagnosis of pulmonary tuberculosis in patients with negative sputum smear microscopy results Márcia Jacomelli, Priscila Regina Alves Araújo Silva, Ascedio Jose Rodrigues, Sergio Eduardo Demarzo, Márcia Seicento, Viviane Rossi Figueiredo Resumo Objetivo: Avaliar a acurácia diagnóstica da broncoscopia em pacientes com suspeita clínica ou radiológica de tuberculose, com baciloscopia negativa ou incapazes de produzir escarro. Métodos: Estudo transversal prospectivo de 286 pacientes com suspeita clínica/radiológica de tuberculose pulmonar e submetidos à broncoscopia — LBA e biópsia transbrônquica (BTB). As amostras de LBA foram testadas por pesquisas diretas e culturas de BAAR e de fungos, e as de BTB por exame histopatológico. Resultados: Dos 286 pacientes estudados, a broncoscopia contribuiu para o diagnóstico em 225 (79%): tuberculose pulmonar em 127 (44%); inflamações crônicas inespecíficas em 51 (18%); pneumocistose, infecções fúngicas ou nocardiose em 20 (7%); bronquiolite obliterante com pneumonia em organização, alveolites ou pneumoconioses em 14 (5%); neoplasias pulmonares ou metastáticas em 7 (2%); e micobacterioses não tuberculosas em 6 (2%). Para o diagnóstico de tuberculose, o LBA mostrou sensibilidade e especificidade de 60% e 100% respectivamente, havendo um aumento importante da sensibilidade quando associado à biópsia (84%) e à baciloscopia após a broncoscopia (94%). Complicações controláveis decorrentes do procedimento ocorreram em 5,6% dos casos. Conclusões: A broncoscopia representa um método diagnóstico confiável para pacientes com tuberculose pulmonar, apresentando baixos índices de complicações. A associação de biópsia transbrônquica ao lavado broncoalveolar elevou a sensibilidade diagnóstica do método e permitiu o diagnóstico diferencial com outras doenças.
    [Show full text]
  • Cryptogenic Organizing Pneumonia
    462 Cryptogenic Organizing Pneumonia Vincent Cottin, M.D., Ph.D. 1 Jean-François Cordier, M.D. 1 1 Hospices Civils de Lyon, Louis Pradel Hospital, National Reference Address for correspondence and reprint requests Vincent Cottin, Centre for Rare Pulmonary Diseases, Competence Centre for M.D., Ph.D., Hôpital Louis Pradel, 28 avenue Doyen Lépine, F-69677 Pulmonary Hypertension, Department of Respiratory Medicine, Lyon Cedex, France (e-mail: [email protected]). University Claude Bernard Lyon I, University of Lyon, Lyon, France Semin Respir Crit Care Med 2012;33:462–475. Abstract Organizing pneumonia (OP) is a pathological pattern defined by the characteristic presence of buds of granulation tissue within the lumen of distal pulmonary airspaces consisting of fibroblasts and myofibroblasts intermixed with loose connective matrix. This pattern is the hallmark of a clinical pathological entity, namely cryptogenic organizing pneumonia (COP) when no cause or etiologic context is found. The process of intraalveolar organization results from a sequence of alveolar injury, alveolar deposition of fibrin, and colonization of fibrin with proliferating fibroblasts. A tremen- dous challenge for research is represented by the analysis of features that differentiate the reversible process of OP from that of fibroblastic foci driving irreversible fibrosis in usual interstitial pneumonia because they may determine the different outcomes of COP and idiopathic pulmonary fibrosis (IPF), respectively. Three main imaging patterns of COP have been described: (1) multiple patchy alveolar opacities (typical pattern), (2) solitary focal nodule or mass (focal pattern), and (3) diffuse infiltrative opacities, although several other uncommon patterns have been reported, especially the reversed halo sign (atoll sign).
    [Show full text]