Pneumoconiosis diagnostic criteria

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dushka Riaz, MD

The initial imaging done for pneumoconiosis is a chest x-ray. This serves as a screening test. High-resolution CT follows and is more sensitive and specific. HRCT can identify those diseases missed by chest radiograph. Pathognomonic for asbestosis is pleural thickening with pleural plaques. Silicosis would show round opacities in the upper lung. Massive fibrosis can be seen in both coal worker’s pneumoconiosis and silicosis. ^{[1] [2] [3] [4]}

1. Radiologic tests must be performed to test for asbestosis when:

• The patient has had exposure to asbestos (with Helsinki criteria indicating the dose being at least 25 fibre/ml.years)
• The CT scan would show pulmonary fibrosis, pleural thickening and pleural plaques. ^{[5] [6]}

2. The best test for silicosis is a high resolution CT:

• It would show widespread fibrosis with bilateral nodules and evidence of involvement of lymph nodes. It can be confirmed with lung biopsy showing acellular whorls, and bi-refringent crystals of silica. ^[7]

3. Coal worker’s pneumoconiosis also presents similarly to silicosis on HRCT:

• Nodular opacities are seen with preference for upper lobes as well as massive pulmonary fibrosis. ^[8]

4. Berylliosis cases should have testing completed as well:

• A blood beryllium lymphocyte proliferation test is the screening test of choice for those suspected of berylliosis. ^[9]
• CT scans would show ground glass opacities as the earliest sign. ^{[10] [11]}

To be qualified as a pneumoconiosis or occupational disease there must be four criteria met:

• This includes documented exposure to the particle.
• Latent period before the development of symptoms.
• Clinical signs and symptoms that entail the disease
• Exclusion of other disease modalities. ^[12]

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