Chest x-ray has low sensitivity to detect silicosis in artificial stone benchtop industry workers.

BACKGROUND AND OBJECTIVE: Chest x-ray (CXR) remains a core component of health monitoring guidelines for workers at risk of exposure to crystalline silica. There has however been a lack of evidence regarding the sensitivity of CXR to detect silicosis in artificial stone benchtop industry workers. METHODS: Paired CXR and high-resolution computed tomography (HRCT) images were acquired from 110 artificial stone benchtop industry workers. Blinded to the clinical diagnosis, each CXR and HRCT was independently read by two thoracic radiologists from a panel of seven, in accordance with International Labour Office (ILO) methodology for CXR and International Classification of HRCT for Occupational and Environmental Respiratory Diseases. Accuracy of screening positive (ILO major category 1, 2 or 3) and negative (ILO major category 0) CXRs were compared with identification of radiological features of silicosis on HRCT. RESULTS: CXR was positive for silicosis in 27/110 (24.5%) workers and HRCT in 40/110 (36.4%). Of the 83 with a negative CXR (ILO category 0), 15 (18.1%) had silicosis on HRCT. All 11 workers with ILO category 2 or 3 CXRs had silicosis on HRCT. In 99 workers ILO category 0 or 1 CXRs, the sensitivity of screening positive CXR compared to silicosis identified by HRCT was 48% (95%CI 29-68) and specificity 97% (90-100). CONCLUSION: Compared to HRCT, sensitivity of CXR was low but specificity was high. Reliance on CXR for health monitoring would provide false reassurance for many workers, delay management and underestimate the prevalence of silicosis in the artificial stone benchtop industry.

Demographic, exposure and clinical characteristics in a multinational registry of engineered stone workers with silicosis.

OBJECTIVES: To investigate differences in workplace exposure, demographic and clinical findings in engineered stone (ES) workers from a multinational consortium using the Engineered Stone Silicosis Investigators (ESSI) Global Silicosis Registry. METHODS: With ethics board approval in Israel, Spain, Australia and the USA, ES workers ages 18+ with a physician diagnosis of work-related silicosis were enrolled. Demographic, occupational, radiologic, pulmonary function and silica-related comorbidity data were compared cross-sectionally among countries using analysis of variance, Fisher's exact tests and logistic regression. RESULTS: Among 169 ES workers with silicosis, most were men, with mean age 51.7 (±11.4) years. Mean work tenure in stone fabrication or masonry was 19.9 (±9.8) years. Different methods of case ascertainment explained some inter-country differences, for example, workers in Queensland, Australia with a state-based surveillance program were likely to be identified earlier and with shorter work tenure. Overall, 32.5% of workers had progressive massive fibrosis, the most severe form of dust-related pneumoconiosis, of whom 18.5% reported ≤10 years of work tenure. Lung function impairment including restriction, reduced diffusion capacity and hypoxaemia was common, as was autoimmunity. CONCLUSIONS: Findings from a multinational registry represent a unique effort to compare demographic, exposure and clinical information from ES workers with silicosis, and suggest a substantial emerging population of workers worldwide with severe and irreversible silica-associated diseases. This younger worker population is at high risk for disease progression, multiple comorbidities and severe disability. The ESSI registry provides an ongoing framework for investigating epidemiological trends and developing prospective studies for prevention and treatment of these workers.

Case series analysis of eight underground tunnellers with chronic silicosis in Queensland.

Within Australia, chronic silicosis has been long thought of as being a well-controlled occupational lung disease. While recent cases of acute silicosis in artificial stone benchtop cutters have emerged, chronic silicosis within the general workforce population has not been recorded. Our case series describes the re-emergence of chronic silicosis amongst workers within the tunnelling industry representing the potential for a more widespread insidious occupational lung disease. While undertaking pre-employment medicals, eight tunnellers have been diagnosed with chronic silicosis. These eight tunnellers had a minimum of 10 years of cumulative dust exposure prior to diagnosis. Diagnosis was made by radiological evaluation of chest X-rays and computerized tomography scans by International Labour Organization B Readers. The re-emergence of chronic pneumoconiosis as illustrated by this case series suggests the presence of undiagnosed occupational lung disease with far reaching implications for workers, employers, compensation systems, and the public healthcare sectors.

Respiratory surveillance for coal mine dust and artificial stone exposed workers in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand.

Coal mine lung dust disease (CMDLD) and artificial stone (AS) silicosis are preventable diseases which have occurred in serious outbreaks in Australia recently. This has prompted a TSANZ review of Australia's approach to respiratory periodic health surveillance. While regulating respirable dust exposure remains the foundation of primary and secondary prevention, identification of workers with early disease assists with control of further exposure, and with the aims of preserving lung function and decreasing respiratory morbidity in those affected. Prompt detection of an abnormality also allows for ongoing respiratory specialist clinical management. This review outlines a medical framework for improvements in respiratory surveillance to detect CMDLD and AS silicosis in Australia. This includes appropriate referral, improved data collection and interpretation, enhanced surveillance, the establishment of a nationwide Occupational Lung Disease Registry and an independent advisory group. These measures are designed to improve health outcomes for workers in the coal mining, AS and other dust-exposed and mining industries.

What does coal mine dust lung disease look like? A radiological review following re-identification in Queensland.

INTRODUCTION: Coal mine dust lung disease (CMDLD), including the pneumoconioses, dust-related diffuse fibrosis (DDF) and chronic obstructive pulmonary disease (COPD), are occupational lung diseases attributed to respirable coal mine dust. Following the re-identification of CMDLD in Queensland in 2015, we undertook a case series to understand their radiological presentation. METHODS: Chest radiographs and high-resolution computed tomography (HRCT) were retrospectively reviewed for 79 male individuals diagnosed by a respiratory physician with a CMDLD since 2015. Radiological findings were characterised as per the International Labour Office Classification System (ILO system) and the International Classification of HRCT for Occupational and Environmental Respiratory Diseases (ICOERD). RESULTS: Subjects with pneumoconiosis (n = 56) demonstrated widespread opacities with bilateral upper zone predominance. The majority of the lung was impacted, with 72% and 79% of zones demonstrating opacities on chest radiograph and HRCT, respectively. Most pneumoconiosis subjects (71%) demonstrated ILO category 1 disease, while 29% had advanced disease (ILO grades ≥ 2/1). A high proportion (81%) of pneumoconiosis subjects demonstrated at least one radiological feature associated with exposure to respirable crystalline silica (RCS). DDF subjects (n = 5) had radiologically severe disease (mean ILO 2/1) with lower zone-predominant irregular opacities. Widespread emphysema, with no zone dominance, was the key radiological feature in those with COPD (n = 18). CONCLUSION: Radiological findings of particular interest included the high burden of opacities observed and the presence of RCS-associated features in the majority of subjects. Radiologists are at the front line in occupational lung disease screening/diagnosis and must be aware of the imaging spectrum.

Radiological appearance of coal mine dust lung diseases in Australian workers.

Coal Mine Dust Lung Disease (CMDLD) encompasses a spectrum of lung diseases caused by prolonged exposure to coal mine dust. This review presents high-resolution computed tomography (HRCT) images from men diagnosed with a CMDLD since the resurgence of these diseases in Queensland in 2015.

Novel MRI of mediastinal masses: internal differentiation of a thymoma and lymphoma with T1 and T2 mapping.

Routine imaging for mediastinal malignancies includes chest X-ray, CT or MRI. T1 and T2 mapping are novel MRI techniques which may have a role in expanding the assessment of internal tumour characteristics. This case report details two middle-aged women who had similar clinical presentations of mediastinal masses of comparable size and appearance when assessed with routine imaging. T1 and T2 maps were acquired on MRI to investigate whether these tumours could be further differentiated prior to surgery. T1 and T2 mapping supported suspicion for which tumour components were solid and cystic, as subsequently confirmed histologically. Furthermore, comparison between the two tumours showed native T1 values differed within the solid components by 37%, correlating to differences in proteinaceous material within the tumour types. This radiological-pathological correlation provides evidence that T1 and T2 mapping has clinical utility in the assessment and differentiation of mediastinal masses.

Regression of cardiac amyloidosis following stem cell transplantation: a comparison between echocardiography and cardiac magnetic resonance imaging in long-term survivors.

BACKGROUND: AL amyloidosis and multiple myeloma result in extracellular deposition of insoluble fibrillary protein in tissue and organs. Untreated median survival is very poor, and even worse with cardiac involvement. Chemotherapy and peripheral blood stem cell transplantation (PBSCT) have been shown to dramatically improve survival, with hematologic remission documented. Regression of cardiac changes has previously been shown, as assessed by echocardiography (TTE) and cardiac magnetic resonance imaging (CMR). This study is a comparison of TTE and CMR in long-term survivors of cardiac amyloidosis with regression. RESULTS: Four long-term survivors with cardiac amyloidosis and regression of cardiac features on TTE were identified. Mean age was 60 years and average survival was 139 months from the time of diagnosis of cardiac involvement. Statistically significant regression of the cardiac features of cardiac amyloidosis were demonstrated on TTE. In these survivors, post-PBSCT structural assessments were similar between TTE and CMR. Classical strain imaging features of cardiac amyloidosis were only present in 50%. All patients had diffuse, patchy gadolinium enhancement on CMR after PBSCT. CONCLUSIONS: Treatment of cardiac amyloidosis with chemotherapy and PBSCT may result in regression of abnormalities on TTE with marked improvement in survival. Post treatment, TTE and CMR structural assessments appear similar. Gadolinium imaging suggests that microscopic residual infiltration persists despite macroscopic regression. Significant cardiac improvements with prolonged survival are seen nonetheless. Multimodality imaging has a vital role in the management of cardiac amyloidosis.

Fat embolism syndrome: State-of-the-art review focused on pulmonary imaging findings.

BACKGROUND: Fat embolism syndrome (FES) is a rare but potentially fatal complication of trauma or orthopedic surgery, which presents predominantly with pulmonary symptoms. Modern intensive care has improved the mortality rates, however diagnosis remains difficult, relying predominantly on a combination of a classic triad of symptoms and non-specific, but characteristic radiological features. The aim of this review is to describe the main clinical and imaging aspects of FES, ranging from pathophysiology to treatment with emphasis on pulmonary involvement. METHODS: We reviewed the currently published literature on the main characteristics of FES. RESULTS: In a hypoxic patient with recent trauma or orthopedic surgery, the presence of diffuse, well-demarcated ground glass opacities or ill-defined centrilobular nodules on computed tomography (CT) of the chest are suggestive of FES. CONCLUSIONS: Combination of the classic clinical syndrome in the appropriate clinical setting, together with the characteristic imaging findings on chest CT, can help to achieve the correct diagnosis. Management remains predominantly supportive care, and the benefit of medical therapies such as corticosteroids and heparin remains unclear.

Fat embolism syndrome: Do the CT findings correlate with clinical course and severity of symptoms? A clinical-radiological study.

OBJECTIVE: Fat embolism syndrome (FES) is rare and diagnosis is challenging. Clinical manifestations are non-specific and no biochemical tests are reliable for diagnosis, highlighting the importance of thoracic CT. Our goal was to describe the CT manifestations of FES and assess whether imaging findings, time of onset of symptoms and time of surgery correlate with clinical course and severity of the disease. METHODS: Retrospective review of 49 patients with respiratory distress after trauma/intramedullary nail fixation over a 10 year period; 12 patients met clinical criteria and were categorized as non-fulminant (NF-FES) or fulminant FES (F-FES). CT images were analyzed and electronic records reviewed for clinical findings, timeline from trauma to surgery and onset of symptoms. Pearson Chi-square and Levene's test were used and results considered significant when p<0.05. RESULTS: All patients were men (18-80 years, mean 38 years), 5 (42%) suffered F-FES and 7 (58%) NF-FES. The most common CT finding was ground-glass opacities (8/12, 67%), often with lobular sparing. Consolidation occurred in 4/12 (33%), all in F-FES patients (p=0.004). In 5/5 F-FES, lung involvement was extensive (>75%) whereas most NF-FES had limited involvement (p<0.01). Centrilobular nodules were the predominant finding in 3/12 (16%). Median time between fracture and onset of symptoms was 43h, in 9/12 patients manifesting after surgery. Mean time between trauma and surgery was 20h in NF-FES and 52h in F-FES (p=0.02). CONCLUSIONS: The most common CT features of FES were ground-glass opacity and consolidation, less commonly, centrilobular nodules. The extent of ground-glass opacities and the presence of consolidation correlated with disease severity. Significant difference was found from time of trauma to surgery in the two groups however is uncertain whether delayed surgery truly increased the risk of F-FES.