Imagem nas doenças ocupacionais pulmonares / Imaging in occupational lung diseases

A presente revisão apresenta as características radiográficas e tomográficas das principais doenças ocupacionais respiratórias (silicose e asbestose). Em especial, enfatiza-se a relevância prática da tomografia computadorizada de alta resolução, método mais sensível e específico para a detecção e quantificação da extensão das lesões pleuroparenquimatosas a elas relacionadas.

This chapter consists of a review of the literature regarding radiographic and tomographic characteristics of the principal occupational respiratory diseases (silicosis and asbestosis). Special attention is given to the practical relevance of high-resolution computed tomography, which is the most sensitive and specific method of identifying and quantifying the extent of pleural and parenchymal lesions related to such diseases.

Pleural plaques in asbestos-exposed workers: reproducibility of a new high-resolution CT visual semiquantitative measurement method.

OBJECTIVE: To assess the reproducibility of a new high-resolution computed tomography (CT) visual semiquantitative method for pleural plaques in asbestos-exposed workers. MATERIAL AND METHODS: We performed thin-section CT in 752 chrysotile asbestos mining workers and ex-workers. Institutional review board approval and signed written informed consent from subjects were obtained. Two readers independently evaluated the 752 CT scans and identified 57 workers (mean age +/- SD, 61.8 years +/- 8.1; range, 37 to 81 years) who had pleural plaques and no other pleural or parenchymal abnormality. Three independent radiologists then quantified the plaque burden in these 57 workers using a scoring system based on the evaluation of the maximum thickness of parietal pleural plaques and percentage of parietal pleural surface involvement. We also calculated the proportion between the number of CT slices with diaphragmatic plaques and the total number of slices in which the diaphragm was seen (pdiaph). The intraobserver and interobserver agreements were analyzed using weighted Kappa coefficient. RESULTS: Interobserver agreements were good for the pleural plaque score (k = 0.61, 0.75, and 0.79) and ranged from good (k = 0.61) to excellent (k = 0.86) for the pdiaph. Intraobserver agreements ranged from good to excellent for the pleural plaque score (k = 0.79 and 1.00) and for the pdiaph (k = 0.79 and 0.93). CONCLUSION: The method proposed for high-resolution CT pleural plaque quantification in asbestos-exposed workers has a high reproducibility.

[Imaging in occupational lung diseases]. / Imagem nas doenças ocupacionais pulmonares.

This chapter consists of a review of the literature regarding radiographic and tomographic characteristics of the principal occupational respiratory diseases (silicosis and asbestosis). Special attention is given to the practical relevance of high-resolution computed tomography, which is the most sensitive and specific method of identifying and quantifying the extent of pleural and parenchymal lesions related to such diseases.

Sarcoidose pulmonar: achados na tomografia computadorizada de alta resolução

A sarcoidose é uma doença sistêmica de causa indeterminada, caracterizada por granulomas não-caseosos. Embora possa afetar qualquer órgão, esta doença tem sua morbi-mortalidade relacionada principalmente ao acometimento pulmonar, presente em 80 por cento a 90 por cento dos pacientes. Este artigo ilustra as principais manifestações pulmonares da sarcoidose na tomografia computadorizada de alta resolução, incluindo as formas típicas e atípicas.

Dispnéia crônica e alterações funcionais respiratórias em ex-trabalhadores com asbestose avaliados para concessão de benefício / Chronic dyspnea and altered respiratory function in former workers with asbestosis evaluated to determine benefits

INTRODUÇAO: A dispnéia é um sintoma de difícil avaliação, principalmente nas doenças ocupacionais. OBJETIVO: Avaliar a relação entre presença e intensidade de dispnéia crônica, e sua repercussão funcional em ex-trabalhadores com asbestose na avaliação de disfunção e incapacidade. MÉTODO: Escores de dispnéia pelas escalas Medical Research Council modificada, American Medical Association de 1984 e 1993 e Baseline Dyspnea Index foram obtidos em 40 ex-trabalhadores com diagnóstico de asbestose, os quais foram também submetidos a espirometria, medidas da capacidade de difusão pulmonar do monóxido de carbono e testes de exercício cardiopulmonar incremental e submáximo. RESULTADO: Dispnéia esteve presente em 72,5 por cento e 67,5 por cento dos indíviduos de acordo com as escalas do Medical Research Council e American Medical Association de 1984, respectivamente e em apenas 37,5 por cento e 31,6 por cento dos pacientes de acordo com as escalas American Medical Association de 1.993 e Baseline Dyspnea Index. Houve melhor concordância entre as escalas Medical Research Council e American Medical Association de 1993, e American Medical Association de 1984 e American Medical Association de 1993 quando as graduações "ausente" e "leve" foram agrupadas. Não foi observada relação significativa entre dispnéia de acordo com cada uma das escalas e presença de anormalidades funcionais no repouso e/ou exercício. CONCLUSAO: O nível de concordância entre as escalas de dispnéia varia significativamente em indivíduos com asbestose. Há falta de relação dos índices de dispnéia com variáveis que avaliam disfunção respiratória em repouso e exercício.

Estudo comparativo entre tomografia computadorizada de alta resoluçäo e radiografia de tórax no diagnóstico da silicose em casos incipientes / Comparative study of high resolution computer-assisted tomography with chest radiofraph inthe diagnosis of silicosis incipient cases

INTRODUÇÄO: A radiografia de tórax (RX) ainda é, no dias atuais, o principal método de diagnóstico da silicose, seguindo-se as normas da Organizaçäo Internacional do Trabalho (OIT). A interpretaçäo radiológica de casos iniciais é dificil, podendo ocorrer divergências mesmo entre leitores experientes. Recentemente, tem sido considerada a possibilidade de utilizaçäo da tomografia computadorizada com técnica de alta resoluçäo (TCAR) para avaliaçäo de casos incipientes. RESULTADOS E CONCLUSÄO: Houve boa concordância entre os métodos quanto à classificaçäo na categoria 0, ou seja, os dois métodos mostraram-se equivalentes para eezcluir o diagnóstico de silicose. Porém, para o diagnóstico da doença, caracterizado por classificaçäo na categoria 1 ou superior, näo foi obtida boa concordância entre os métodos.

Persistent asthma in adults: comparison of high resolution computed tomography of the lungs after one year of follow-up

OBJECTIVE: The aims of this study were to evaluate the role of high resolution computed tomography of the torax in detecting abnormalities in chronic asthmatic patients and to determine the behavior of these lesions after at least one year. METHOD: Fourteen persistent asthmatic patients with a mean forced expiratory volume in 1-second that was 63 percent of predicted and a mean forced expiratory volume in 1-second /forced vital capacity of 60 percent had two high resolution computed tomographys separated by an interval of at least one year. RESULTS: All 14 patients had abnormalities on both scans. The most common abnormality was bronchial wall thickening, which was present in all patients on both computed tomographys. Bronchiectasis was suggested on the first computed tomography in 5 of the 14 (36 percent) patients, but on follow-up, the bronchial dilatation had disappeared in 2 and diminished in a third. Only one patient had any emphysematous changes; a minimal persistent area of paraseptal emphysema was present on both scans. In 3 patients, a "mosaic" appearance was observed on the first scan, and this persisted on the follow-up computed tomography. Two patients had persistent areas of mucoid impaction. In a third patient, mucus plugging was detected only on the second computed tomography. CONCLUSIONS: We conclude that there are many abnormalities on the high resolution computed tomography of patients with persistent asthma. Changes suggestive of bronchiectasis, namely bronchial dilatation, frequently resolve spontaneously. Therefore, the diagnosis of bronchiectasis by high resolution computed tomography in asthmatic patients must be made with caution, since bronchial dilatation can be reversible or can represent false dilatation. Nonsmoking chronic asthmatic subjects in this study had no evidence of centrilobular or panacinar emphysema