pulmonary disorders
Asbestosis
Diagnosis of Asbestosis
Chest x-ray or preferably high-resolution chest CT Sometimes bronchoalveolar lavage or lung biopsy Diagnosis of asbestosis is based on history of exposure to asbestos and chest x-ray or high-resolution CT. History should include onset, duration, and type and intensity of the patient's exposure. Chest x-ray shows bilateral, linear reticular opacities signifying fibrosis, usually in the peripheral lower lobes, with or without Asbestos-Related Pleural Disease . Chest CT offers higher sensitivity in identifying pleural and parenchymal abnormalities, and typically shows a usual interstitial pneumonia pattern of pulmonary fibrosis. Honeycombing, which may involve the mid and lower lung fields, signifies more advanced disease. The International Labor Organization system (International Classification of Radiographs of Pneumoconioses) is used to characterize the presence and severity of pneumoconioses based on size, shape, location, and profusion of opacities. Asbestosis produces reticular opacities with a lower lobe predominance. Hilar and mediastinal adenopathy and nodular opacities are uncharacteristic and suggest a different diagnosis. Overview of Tests of Pulmonary Function may show restriction, reduced diffusing capacity for carbon monoxide (DLCO), and/or mild airflow obstruction. Such findings are nonspecific but help characterize the severity of disease. Bronchoalveolar lavage or lung biopsy is potentially useful when the diagnosis is uncertain. The demonstration of asbestos fibers and/or asbestos bodies can help support the diagnosis but is not required. 