Asbestosis is diffuse interstitial pulmonary fibrosis associated with asbestos fiber inhalation. The typical chest radiographic findings in asbestosis are small irregular or reticular opacities, predominating at the lung bases. Honeycombing is evident in more advanced diseases. But chest radiograph is relatively insensitive in detecting the presence of asbestosis. HRCT is more sensitive than simple chest radiograph for diagnosis of asbestosis, especially the early change of asbestosis. The early findings of asbestosis on HRCT are subpleural dotlike opacities and curvilinear opacities. As progression of fibrosis, intralobular interstitial thickening and interlobular septal thickening are presented. In advanced diseases, parenchymal bands, traction bronchiectasis or bronchiolectasis, and honeycombing are noted. These findings are typically located in lower posterior subpleural portions with bilateral symmetric patterns. Imaging findings that are compatible with asbestosis, rale, and a reduced diffusing capacity can increase confidence of diagnosis of asbestosis.
Asbestos ; Asbestosis ; Bronchiectasis ; Fibrosis ; Inhalation ; Lung ; Pulmonary Fibrosis ; Radiography, Thoracic ; Respiratory Sounds ; Thorax ; Tomography, X-Ray Computed ; Traction

The first case of allergic bronchopulmonary aspergillosis(ABPA) was reported by Hinson, et al. in 1952. This was followed by a number of significant description of the disorder. Although typical ABPA initially presents with asthma, fleeting pulmonary infiltrates, and marked eosinophilia, there are many other ways in which the disease may be first manifested. Common radiologic findings in ABPA include pulmonary infiltrates, atelectasis, emphysema, fibrosis, lobar shrinkage with hilar elevation, cavitation, pneumothorax, aspergilloma and central bronchiectasis. We experienced a case of allergic bronchopulmonary aspergillosis presenting rare radiologic finding of bilateral pulmonary masses in chest radiography. With oral corticosteroid treatment, the size of both pulmonary masses was decreased significantly and his asthmatic symptoms were improved.
Aspergillosis, Allergic Bronchopulmonary* ; Asthma ; Bronchiectasis ; Emphysema ; Eosinophilia ; Fibrosis ; Pneumothorax ; Pulmonary Atelectasis ; Radiography ; Thorax

Asbestosis is the most important change noted in the lung parenchyma after environmental and occupational exposure to asbestos fibers. It is characterized by diffuse interstitial pulmonary fibrosis. In Korea, the incidence of asbestosis will continue to increase for many years to come and the government enacted the Asbestos Damage Relief Law in 2011 to provide compensation to those suffering from asbestos-related diseases. Radiologic evaluation is necessary for diagnosis of asbestosis, and radiologists play a key role in this process. Therefore, it is important for radiologists to be aware of the various imaging features of asbestosis.
Asbestos ; Asbestosis* ; Compensation and Redress ; Diagnosis* ; Incidence ; Jurisprudence ; Korea* ; Lung ; Occupational Diseases ; Occupational Exposure ; Pulmonary Fibrosis ; Radiography

BACKGROUND: Idiopathic pulmonary fibrosis(IPF), a subtype of IIP(idiopathic interstitial pneumonia), is a fatal disease with a 3-5 year median survival. Many attempts at treating this condition have failed to demonstrate a survival benefit in IPF. Recently Ziesche et al12 reported the efficacy of IFN-gamma for treating IPF but there is still some controversy. The aim of this study was to determine the efficacy of IFN-gamma in patients with advanced IPF who had not been responsive to steroid and cytotoxic agents. METHOD: Nine patients with advanced IPF(age: 55.4+/-15.3 years, Male: Female=8:1) were enrolled. One year treatment regime with 2 million IU of IFN-gamma administered subcutaneously three times a week, and low dose prednisolone(10-30 mg/d) was also used. In the case of a definite aggravation and serious side effects, the IFN-gamma was discontinued. During the IFN-gamma trial, a pulmonary function test and chest radiography were checked every three month throughout the study. RESULT: 1) Among 9 patients, only 4 patients were able to complete the 12 month treatment with IFN-gamma, and 5 patients died during the treatment period. 2) No improvement either in the respiratory symptoms or pulmonary functions were observed any of the patients, even in those who completed the 12 months trial of IFN-gamma, 3) At the time of IFN-gamma trial, the survivors who finished the IFN-gamma treatment for 12 months had a higher oxygen level(81.3+/-2.8 vs. 67.4+/-8.4, P=0.024) and a better pulmonary function(FVC: 61.3+/-5.1 % predicted vs. 45.7+/-12.3%, P=0.048, and DLco: 45.0+/-5.0% predicted vs. 30.8+/-11.2%, P=0.048) than the non-survivors. CONCLUSION: Our data suggested that IFN-gamma therapy was not effective in the patients with advanced IPF refractory compared with other therapeutic agents. Furthermore, these results suggest that severe impairment of the pulmonary function and hypoxemia during the IFN-gamma therapy requires special attention.
Anoxia ; Cytotoxins ; Humans ; Idiopathic Pulmonary Fibrosis* ; Interferon-gamma ; Male ; Oxygen ; Radiography ; Respiratory Function Tests ; Survivors ; Thorax

BACKGROUND: To compare the diagnostic accuracies of High-resolution CT(HRCT) and chest radiography in the diagnosis of diffuse infiltrative lung disease(DILD). METHODS: This study included ninety-nine patients with a diagnosis of acute or chronic DILD, representing 20 different diseases. Twelve normal subjects were included as control. The disease state was confirmed either pathologically or clinically. Radiographs and CT scans were evaluated separately by three independent observers without knowledge of clinical and pathologic results. The observers listed three most likely diagnoses and recorded degree of confidence. RESULTS: The sensitivity of HRCT in the detection of DILD was 98.9% compared to 97.9% of chest radiography. Overall, a correct first-choice diagnosis was made in 48% using chest radiographs and in 60% using HRCT images. The correct diagnosis was among the top-three choices in 64% when chest radiographs were used, and in 75% when HRCT images were reviewed. Overally a confident diagnosis was reached more often with HRCT(55%) than with chest radiography(26%). The correct first-choice diagnosis increased remarkably when the HRCT was used in usual interstitial pneumonia, miliary tuberculosis, diffuse panbronchiolitis and lymphangitic carcinomatosis. CONCLUSION: HRCT is confirmed to be superior to conventional radiography in the detection and accurate diagnosis of DILD. HRCT is especially valuable in the diagnosis of usual interstitial pneumonia, miliary tuberculosis, diffuse panbronchiolitis, and lymphangitic carcinomatosis.
Carcinoma ; Diagnosis ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung Diseases* ; Lung* ; Radiography* ; Radiography, Thoracic ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis, Miliary

This study assessed main pulmonary artery diameter of patients with anthracofibrosis. Patients with anthracofibrosis and CT scans were evaluated after exclusion of patients with co-existing disease. We measured the diameter of the main pulmonary artery (PAD) and ascending aorta (AD) and calculated the pulmonary artery to aorta ratio (APR). The upper reference limit for comparison of PAD was 29 mm. Cut-off values for PAD and APR indicating pulmonary hypertension were 33 mm and 1. We correlated the CT parameters with echocardiographic results. Total 51 patients were included in the analysis. The mean PAD, AD, and APR were 33 mm, 38 mm, and 0.87 respectively. The PAD was larger than the upper reference limit, 29 mm (P<0.001). The PAD was >33 mm in 30 (65%) and the APR was >1 in 9 patients (18%). Of 21 patients with echocardiography, 11 (52%) were found to have pulmonary hypertension. There was no statistical difference in the diagnosis of pulmonary hypertension between echocardiography and CT (P=1.000). In conclusion, main pulmonary artery is dilated in patients with anthracofibrosis more than in the healthy population.
Aged ; Aged, 80 and over ; Aorta, Thoracic/*radiography ; Bronchi/pathology ; Bronchoscopy ; Dilatation ; Female ; Fibrosis ; Humans ; Hypertension, Pulmonary/*diagnosis/ultrasonography ; Male ; Pulmonary Artery/*radiography ; Tomography, X-Ray Computed

We report a case of pulmonary fibrosis in a 32-year-old man, who had worked at a steel mill and who died of respiratory failure due to interstitial fibrosis despite vigorous treatment. He showed SLE-associated symptoms, such as pleural effusion, malar rashes, discoid rashes, arthritis, leukopenia, and positive antinuclear antibody and anti-histone antibody. However, he did not present anti-DNA antibody. A thoracoscopic lung biopsy showed interstitial fibrosis, chronic inflammation and a small non-caseating granuloma in lung tissues, which could be induced by external agents such as metals. The manganese concentration in the lung tissue was 4.64 microg/g compared to 0.42-0.7 microg/g in the controls. The levels of other metals, such as iron, nickel, cobalt and zinc in patient's lung tissue were higher than those in the controls. The patient was probably exposed to Si and various metal dusts, and the lung fibrosis was related to these exposures. Exposure to Si and metal dusts should be sought in the history of any patient with SLE, especially in a male with pulmonary signs, and if present, exposure should be stopped. In the meantime, steps should be taken to ensure that workers exposure to Si and metal dusts in all environments have adequate protection.
Adult ; Biopsy ; Case Report ; Fatal Outcome ; Human ; Male ; Occupational Diseases/radiography* ; Occupational Diseases/pathology ; Occupational Diseases/chemically induced* ; Occupational Exposure ; Pulmonary Alveoli/pathology ; Pulmonary Fibrosis/radiography* ; Pulmonary Fibrosis/pathology ; Pulmonary Fibrosis/chemically induced* ; Respiratory Insufficiency/radiography ; Respiratory Insufficiency/pathology ; Respiratory Insufficiency/chemically induced ; Steel/adverse effects*

Asbestos industry has been in operation over 60 years in Korea. However, the prevalence of asbestosis has not been yet reported. With rapid turn-over of workers, previous cross-sectional studies of current workers on the job could not find cases with exposures long enough for the development of asbestosis. This study was done to evaluate asbestosis prevalence of those worksites with operation history of more than 20 years. In total, 139 workers from 5 worksites were examined. Asbestos industries covered in the study include 2 asbestos textile, 1 brake lining, and 2 ship repairing worksites. Chest x-ray was taken from all workers and read by two exports familiar with pneumoconiosis classification according to 1980 ILO guidelines. Those with findings compatible with asbestosis were further checked with high resolution computerized tomography (HRCT). Pulmonary function tests were done according to ATS guidelines, and occupational and previous medical history was taken through a standardized interview. Air-borne asbestos was measured according to NI0SH method 7400. The air-borno asbestos concentrations ranged from 0.2-1.3 f/cc for asbestos textile, from 0.7~l.0 f/cc for brake lining, and from 6.3-7.8 f/cc during asbestos removal at ship repairing worksite. Of the 139 workers 25 had abnormal chest radiographic findings, and 10 of them had findings compatible with pneumoconiosis. When work history and current asbestos measurements were accounted, 9 workers who had more than 10 years of asbestos exposure history showed chest radiographic findings of pneumoconiosis with Finally, 4 workers showed finding of pulmonary fibrosis and/or pleural thickening at HRCT, and 2 of them had restrictive lung function changes. The study results showed that, among 139 sutjects, there were 4 (3%) definite asbeatosis cases confirmed with HRCT. The prevalence of probable asbestosis was 7% for 10-14 years of exposure, 13% for 15-19 years of exposure, and 23% for 20 or more years of exposure. The prevalence of compensable asbestosis with abnormal lung function was 4-6% for those with 15 or more years of exposure.
Asbestos* ; Asbestosis* ; Classification ; Korea ; Lung ; Pneumoconiosis ; Prevalence* ; Pulmonary Fibrosis ; Radiography, Thoracic ; Respiratory Function Tests ; Ships ; Textiles ; Thorax ; Workplace

PURPOSE: Radiation-induced fibrotic mass might masquerade as a true hilar tumor mass on a plain chest radiograph. We attempted to differentiate radiation fibrosis from a true hilar tumor using only a plain radiograph. MATERIALS AND METHODS: Plain chest radiographs were obtained from seven patients who had developed radiation fibrosis simulating hilar mass after radiation therapy for lung cancer, and from 19 patients with lung cancer, a comparison group, who had not received radiation therapy. They were reviewed for the obliteration of the overlapped mediastinal and hilar anatomical silhouettes by the mass : pulmonary artery, heart or aorta border, and paraspinal line. RESULTS: All seven patients with radiation-induced fibrotic mass(bilateral lesion in twopatients) showed obliteration of all three overlapped anatomical silhouettes of the mediastinum and hilum on chestradiographs. in the comparison group of 19 patients with a true hilar mass, there was, however, no case which demonstrated obliteration of all landmarks. CONCLUSION: Obliteration of all anatomical landmarks at the hilum and mediastinum may be a helpful clue in the differential diagnosis of radiation-induced fibrotic mass from true hilarmass on a plain radiograph, particularly when clinical information on previous radiation therapy is unavailable.
Aorta ; Arteries ; Diagnosis, Differential ; Fibrosis ; Heart ; Humans ; Lung Neoplasms ; Mediastinum ; Pulmonary Artery ; Radiation Pneumonitis* ; Radiography, Thoracic ; Thorax*

OBJECTIVETo report the clinical features and the prognosis, the methods of diagnosis and treatment, and the early detection of the pulmonary toxicity induced by amiodarone.

METHODThe clinical course, the findings of X-ray and CT and the results of treatment were summarized and analyzed in six patients with amiodarone-induced pulmonary toxicity.

RESULTSFive males, one female, aged 62 - 69 (66.0 +/- 2.4) years. Amiodarone was used because of paroxysmal atrial fibrillation in five patients and ventricular arrhythmia in one. The loading dose was 7 g and the maintaining dose was 0.2 g/d or less. Pulmonary toxicity was recognized at the times in 0.5 - 4.0 (2.1 +/- 1.3) years after amiodarone therapy. Dyspnea occurred, crack rales were audible in both lower parts of the lungs, and the chest X-ray showed grid-like changes in case one. No symptom was found in the others. Their diagnosis was made according to the pulmonary intestinal changes by high-resolution computerized tomography when the lung marking was increased or deranged by chest X-ray during the regular follow-up. Pulmonary function examination showed that the restrictive ventilation and the CO diffusing capacity decreased in case one, while the CO diffusing capacity was normal in the others. The decreased obstructive ventilation capacity was found in case six. Amiodarone was discontinued in all the cases after the diagnosis of induced pulmonary toxicity. One patient was treated with corticosteroid, three with azithromycin, and the another two patients were not treated with drug. During 0.1 - 5.0 year period of follow-up the symptoms were markedly attenuated in case one, and no new symptoms and radiography findings were found in the others.

CONCLUSIONSPulmonary toxicity is a serious adverse effect of amiodarone. The typical feature is pulmonary intestinal fibrosis and thick pulmonary intestine in the early stage. Corticosteroid treatment seems effective. It would be helpful for early diagnosis to take chest X-ray examination regularly and CT examination in suspicions cases during the therapy. The prognosis may be good in the early diagnosed cases.

Aged ; Amiodarone ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Pulmonary Fibrosis ; chemically induced ; diagnostic imaging ; Radiography