• Patients may be asymptomatic, with diagnosis made during chest x-ray (CXR) examination performed for other reasons
• Exam often shows persistent bibasilar fine ‘’crackles’’, often at end-expiration, in one to two-thirds of patients.

  • In advanced disease, markers of severe pulmonary dysfunction may be present, such as clubbing (32-42%), cyanosis, and cor pulmonale. Patients with cor pulmonale may show peripheral edema, jugular venous distension, hepatojugular reflux, and/or a right ventricular heave or gallop.

• Chest radiograph shows irregular linear or nodular opacities

  • These are most commonly seen initially at the bases and the periphery, and they often gradually become visible in the mid and occasionally upper zones of the lung.
  • If seen in conjunction with pleural plaques, the diaphragm and heart border may lose definition, giving rise to the “shaggy heart” sign.
  • Hilar and mediastinal adenopathy is not typical, and suggests another process.

• Chest radiograph is about 80% sensitive for asbestosis, but chest CT is more sensitive, showing abnormalities in 30% of asbestos-exposed individuals with normal CXRs.

  • HRCT typically shows:

    • Basilar and dorsal lung parenchymal fibrosis, with peribronchiolar, intralobular, and interlobular septal fibrosis.
    • Subpleural linear densities parallel to the pleura
    • Coarse parenchymal bands, often contiguous with the pleura
    • Honeycombing in advanced disease
    • Pleural plaques may be present

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