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examination and diagnosis of pneumoconiosis

examination and diagnosis of pneumoconiosis

Common examination of pneumoconiosis

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Lung imagingLungRadiological oncologyIn the diagnosis of pulmonary embolism...
Pulmonary functionMouthDepartment of Respiratory Health CareLung function test for...
Antinuclear antibodyWhole bodyRheumatismAntinuclear antibody (ANA...
Pulmonary diffusion functionLungBreathing heart and chestDiffusion function is to change...
Routine examination of sputumLung--General characteristics of sputum...
Chest CTChest--Chest CT examination can...
Pulmonary ventilation functionLungBreathing heart and chestLung ventilation function can...
Chest X-rayChestHeart and chestThe main purpose of chest X-ray...
Serum angiotensin I converting enzyme activityBlood vessel--Serum vascular tension...
Asbestos corpuscles can be found in sputum or bronchoalveolar lavage fluid, which is evidence of asbestos exposure history. Serum rheumatoid factor was positive. Antinuclear antibody was positive, and pleural effusion was aseptic serous or serous bloody exudate.

1. The pulmonary function changes of asbestosis are typical lung volume reduction, diffusion function impairment and abnormal gas exchange. In the early stage of asbestosis, perialveolar fibrosis, pulmonary diffusion decreased before X-ray did not change. With the development of pulmonary interstitial fibrosis, pulmonary contraction, pulmonary compliance decreased, restricted ventilation dysfunction appeared, FVC, VC and TLC decreased, RV was normal or slightly increased, and pulmonary ventilation/blood flow ratio was out of balance. The late stage was mixed ventilation dysfunction, some cases were complicated with obstructive emphysema, FEV1 decreased and RV/TLC slightly increased.

PaO2 in asbestos lung patients often decreases at rest, but decreases obviously when exerting force. However, PaCO2 rarely increased.

2. X-ray manifestations the X-ray manifestations of asbestosis include pleural changes and lung parenchyma changes. In recent years, it has been found that pleural plaques often appear earlier and more obviously than lung parenchyma changes.

(1) Reticular shadow: It is the main change of asbestosis. In the early stage, there is a fine mesh in the middle and lower lung fields, the mesh diameter is less than 3mm, and in the late stage, it forms a coarse mesh. In the late stage, the thick and dense reticular shadow of the whole lung is honeycomb. The transmittance of lung field decreased, forming ground glass shape, and irregular small dot shadows were often seen in lung field.

(2) Fusion focus: It is more common in the basal part of both lungs, with unclear boundary and small range of flaky shadows.

(3) Pleural change: It can appear at an early stage.

(1) Pleural plaque: Symmetrical triangular shadow in the middle and lower parts of bilateral chest wall, clear inner edge, and occasional irregular shape on one side. Some pleural plaques have calcification.

Pleural thickening, adhesion, lung apex pleura, lateral chest wall, pleural angle, interlobar pleura thickening. Thickening of parietal pleura is common in the center of anterior chest wall and diaphragm top. The adhesion between pericardium and parietal pleura can form a "hair-like heart shadow".

③ Exudative pleural effusion: repeated occurrence in bilateral pleural cavity.

(4) Hilar NodeThe density of structural disorder increased, but there was no lymph node enlargement.

The role of conventional CT scanning in the diagnosis of asbestosis is still controversial. Some people think that conventional CT scanning is significantly more sensitive than conventional chest X-ray in early detection of pleural thickening and pulmonary parenchymal fibrosis in people exposed to asbestos. High resolution CT (HRCT) may be of greater diagnostic value. Aberle et al. compared the value of HRCT and conventional CT in diagnosing asbestos lung in 29 patients with occupational asbestos exposure history. These 29 patients had mild to severe abnormalities on standard chest radiographs, suggesting the diagnosis of asbestosis. They found that HRCT is more sensitive than conventional CT in showing pleural plaque and pulmonary parenchymal fibrosis. At the same time, some studies have shown that HRCT can find abnormalities in pleura and lung parenchyma in some patients with normal chest radiographs.

The characteristic manifestations of asbestosis on HRCT include: ① linear shadows with different lengths parallel to pleura; 2 ~ 5cm long line shadow is penetrated through the lung and can extend to the surface of pleura; The thickening of interlobular septal line and the thickening of secondary pulmonary lobule structure; ④ Honeycomb lung changes.


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