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Progression from Near-Normal to End-Stage Lungs in Chronic Interstitial Pneumonia Related to Silica Exposure: Long-Term CT Observations

Hiroaki Arakawa1, Kiminori Fujimoto2, Koichi Honma3, Narufumi Suganuma4, Hiroshi Morikubo5, Yoshiaki Saito6, Hisao Shida5 and Yasushi Kaji1

1 Department of Radiology, Dokkyo Medical University School of Medicine, 880 Kita-Kobayashi, Mibu, Utsunomiya, Tochigi 321-0293, Japan.
2 Department of Radiology, Kurume University School of Medicine, Kurume City, Japan.
3 Department of Pathology, Dokkyo Medical University School of Medicine, Utsunomiya, Tochigi, Japan.
4 Department of Environmental Health, Kochi University School of Medicine, Nankoku, Japan.
5 Department of Radiology, Rosai Hospital for Silicosis, Nikko, Japan.
6 Department of Respiratory Medicine, Rosai Hospital for Silicosis, Nikko, Japan.


Figure 1
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  		Fig. 1 —Graph shows extent of fibrosis as function of time. Linear relationship between fibrosis score and time is seen in all patients except one. Slope of line in each patient ranged from 0.306 to 4.633 and correlation coefficients ranged from 0.568 to 0.964. In one patient, linear correlation was not available because of small number of serial CT scans.

 

Figure 2
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  		Fig. 2 —Graph shows grade of coarseness as function of time. Linear relationship between coarseness score and time is seen in 12 of 14 patients. Slope of lines ranged from 0.179 to 0.479 and correlation coefficient from 0.815 to 0.981. In two patients, correlation was not significant probably because of small number of serial CT scans.

 

Figure 3
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  		Fig. 3A —Chronic interstitial pneumonia in 63-year-old man who previously worked as metal ore miner and who had silicosis. Initial CT image obtained at level of right lung base shows only faint ground-glass opacity in periphery. This abnormality was limited to only lung bases.

 

Figure 4
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  		Fig. 3B —Chronic interstitial pneumonia in 63-year-old man who previously worked as metal ore miner and who had silicosis. Thin-section CT image obtained 14 years after A reveals increased density and extent of ground-glass opacity and development of reticular opacity. Many tiny cystic spaces can be seen just beneath pleural surface indicating early honeycombing. Honeycomb cysts are obvious in lung base at this time.

 

Figure 5
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  		Fig. 3C —Chronic interstitial pneumonia in 63-year-old man who previously worked as metal ore miner and who had silicosis. Photomicrograph of pathologic specimen obtained 6 months after B shows honeycombing in subpleural zone (arrows). Pathologic diagnosis was usual interstitial pneumonia pattern.

 

Figure 6
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  		Fig. 4A —Chronic interstitial pneumonia in 57-year-old man who previously worked as stonemason. Initial CT image shows faint ground-glass opacity confined to lung bases.

 

Figure 7
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  		Fig. 4B —Chronic interstitial pneumonia in 57-year-old man who previously worked as stonemason. Thin-section CT image obtained 16 years after A reveals obvious honeycombing in area of ground-glass opacity.

 

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