DOI:10.2214/AJR.05.0865
AJR 2007; 188:326-333
© American Roentgen Ray Society
Inhalational Talc Pneumoconiosis: Radiographic and CT Findings in 14 Patients
Masanori Akira1,
Takenori Kozuka1,
Satoru Yamamoto2,
Mitsunori Sakatani3 and
Kenji Morinaga4
1 Department of Radiology, Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho,
Sakai City, Osaka 591-8555, Japan.
2 Department of Pathology, Kinki-Chuo Chest Medical Center, Osaka 591-8555,
Japan.
3 Department of Internal Medicine, Kinki-Chuo Chest Medical Center, Osaka
591-8555, Japan.
4 Department of Environmental Health, National Institute of Industrial Health,
Kawasaki 214-8585, Japan.
Received May 23, 2005;
accepted after revision August 9, 2005.
Address correspondence to M. Akira.
Abstract
OBJECTIVE. The purpose of this study was to evaluate the
radiographic and CT findings of inhalational talc pneumoconiosis.
CONCLUSION. Large opacities of talc pneumoconiosis progress more
often than do small opacities. The CT findings of talc pneumoconiosis overlap
those of silicosis and asbestosis.
Keywords: chest • high-resolution CT • lung • pneumoconiosis • radiography • talc • thin-section CT
Introduction
Thorel [1] reported
the first case of talc pneumoconiosis in 1896. Since then talc has been
recognized as a cause of pneumoconiosis in miners, millers, rubber workers,
and other occupational groups
[2]. Talc is pure hydrous
magnesium silicate with an ideal chemical composition of 63.5%
SiO2, 31.7% MgO, and 4.8% H2O, but in practice
substitutions of ions occur in the mineral lattice or the talc is contaminated
by other minerals [3]. The
chest radiographic manifestations of talc pneumoconiosis have been well
described
[4-8].
The CT features of talcosis due to IV administration of talc have been
reported
[9-11].
To our knowledge, however, the CT features of talc pneumoconiosis due to
occupational talc exposure have not been well described
[12,
13]. We present the
radiographic and CT manifestations and serial changes on chest radiographs of
14 patients with pathologically proved talc pneumoconiosis.
Materials and Methods
Patients
The study included 14 patients with pathologically proved talc
pneumoconiosis consecutively admitted to our hospital between 1973 and 1998.
The diagnosis was based on clinical history, occupational exposure to talc
dust, and histologic findings obtained at transbronchial lung biopsy
(n =8) or autopsy (n = 6). A thoracic pathologist reviewed
the pathologic specimens. The pathologic findings of talc pneumoconiosis
included diffuse interstitial fibrosis, ill-defined fibrotic nodules, and
foreign body granulomas associated with dense accumulations of birefringent
talc dust particles [1,
3]. All patients were men. The
mean age was 59 years (range, 40-71 years) at initial evaluation. Mean
duration of exposure to talc dust was 19 years (range, 8-35 years). Eight
patients worked in a talc factory. Four patients were exposed to talc dust
used in the manufacture of rubber products. One patient was exposed to talc
dust used as an additive in a cosmetics factory, and one to talc dust used as
an additive in a confectionery. Eleven patients ceased work after the initial
evaluation. Ten patients were smokers, and four never smoked. Smokers had a
smoking history ranging from 18 to 69 pack-years (mean, 36.3 pack-years).
The patients underwent follow-up chest radiography. Serial radiographs were
available for all patients during a mean follow-up period of 16 years (range,
6-25 years). All patients underwent one or more CT examinations between 1988
and 2004. Chest radiographs obtained within 1 week of CT were available for
all patients. After 6-25 years of follow-up, four patients had died of
respiratory failure, one patient had died of myocardial infarction, and one
had died of cerebral infarction. The postmortem lungs from one patient were
inflated, fixed in formalin, and subjected to thin-section CT and
low-kilovoltage radiography. Informed consent was provided by the patients,
and the study was approved by the internal review board at the hospital.
Chest Radiographic Evaluation
Two reviewers independently interpreted the radiographs according to the
1980 International Labor Organization classification of pneumoconiosis
[14]. The reviewers were a
respiratory physician with a special interest in pneumoconiosis and a thoracic
radiologist; both were certified by the National Institute for Occupational
Safety and Health. The radiographs were interpreted in random order. Profusion
of small opacities was scored with the International Labor Organization
grading system on the basis of the viewer's assessment of the concentration of
opacities compared with standard radiographs provided by the International
Labor Organization [14].
View larger version (135K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1A —61-year-old man with inhalational talc pneumoconiosis employed in
talc industry for 20 years. Initial chest radiograph shows fine nodular
opacities diffusely distributed throughout both lungs.
|
|
View larger version (154K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1B —61-year-old man with inhalational talc pneumoconiosis employed in
talc industry for 20 years. Chest radiograph obtained at 15-year follow-up
examination shows fine nodules and large opacity in upper zone of right lung
and middle zone of left lung.
|
|
View larger version (120K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1C —61-year-old man with inhalational talc pneumoconiosis employed in
talc industry for 20 years. Axial supine thin-section CT scan shows
well-defined (arrowheads) and ill-defined (arrows) small
nodular opacities mainly distributed in centrilobular location.
|
|
View larger version (90K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1D —61-year-old man with inhalational talc pneumoconiosis employed in
talc industry for 20 years. Axial supine thin-section CT scan obtained at
mediastinal settings shows large opacity and lymph nodes containing
high-attenuation material.
|
|
In the International Labor Organization system, profusion of small
opacities is recorded on a 12-point incremental scale together with the
predominant type of opacity. Category 0 includes scores 0/-, 0/0, and 0/1;
category 1, scores 1/0, 1/1, and 1/2; category 2, scores 2/1, 2/2, and 2/3;
and category 3, scores 3/2, 3/3, and 3/+. For small rounded opacities, the
three size ranges are denoted by the letters p, q, and r: p indicates
opacities with diameters up to approximately 1.5 mm; q, opacities 1.5-3 mm in
diameter; and r, opacities 3-10 mm in diameter. The three size ranges of small
irregular opacities are denoted by the letters s, t, and u: s indicates
opacities with a width up to approximately 1.5 mm; t, opacities 1.5-3 mm in
width; and u, opacities 3-10 mm in width. A large opacity is defined as an
opacity exceeding 10 mm in longest dimension. The categories of large
opacities are as follows: A, one large opacity up to approximately 50 mm in
longest dimension or several large opacities with the sum of longest
dimensions not exceeding approximately 50 mm; B, one large opacity exceeding
50 mm in longest dimension but not exceeding the equivalent area of the right
upper zone or several large opacities with the sum of longest dimensions
exceeding 50 mm but not exceeding the equivalent area of the right upper zone;
and C, one large opacity exceeding the equivalent area of the right upper zone
or several large opacities that combined exceed the equivalent area of the
right upper zone.
View larger version (151K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 2B —57-year-old man with inhalational talc pneumoconiosis employed in
talc industry for 14 years. Chest radiograph obtained at 13-year follow-up
examination shows large opacities associated with bilateral superior
retraction of hila.
|
|
View larger version (91K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 2D —57-year-old man with inhalational talc pneumoconiosis employed in
talc industry for 14 years. In vitro low-kilovoltage radiograph of inflated
and fixed lung. Crescent-shaped large opacity and small nodular opacities are
evident.
|
|
View larger version (89K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 2E —57-year-old man with inhalational talc pneumoconiosis employed in
talc industry for 14 years. In vitro thin-section CT scan of inflated and
fixed lung. Crescent-shaped large opacity is attached to pleural surface.
Subpleural line (arrows) is evident.
|
|
View larger version (139K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 2F —57-year-old man with inhalational talc pneumoconiosis employed in
talc industry for 14 years. Photograph of histologic section through
crescentic large opacity shows diffuse fibrosis and proliferation of
dust-laden macrophages and multinucleated giant cells (arrows). (H
and E, x4)
|
|
When the findings of the two observers did not agree, a third reviewer
resolved the differences. For assessment of the sequential changes in large
opacities, all radiographs for each patient were examined in side-by-side
review in chronologic order by one chest radiologist.
CT Images
Thin-section CT was performed with a Quantex Plus or a LightSpeed CT unit
(GE Healthcare). All CT scans were obtained at maximal inspiration with 1.5-mm
collimation at 20-mm intervals. CT scans at maximal expiration were added for
two patients whose inspiratory CT scans showed lobular low-attenuation areas.
Scanning extended from the lung apices to below the costophrenic angles.
Images were reconstructed with a high-spatial-frequency algorithm. CT scans
were obtained with the patient in the supine position. The images were
photographed on hard copy at lung (window width, 1,200 H; level, -700 H) and
soft-tissue (window width, 300 H; level, 10 H) settings.
CT Evaluation
The CT images were reviewed independently by two chest radiologists unaware
of the clinical and radiographic data. The final decisions on CT findings were
reached by consensus. The reviewers evaluated the scans for the presence and
distribution of ground-glass opacity, septal lines, subpleural lines, small
rounded opacities, centrilobular nodules, small irregular opacities, large
opacities, traction bronchiectasis, honeycombing, lobular low-attenuation
areas, and emphysema [15,
16].
View larger version (125K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 2G —57-year-old man with inhalational talc pneumoconiosis employed in
talc industry for 14 years. Photomicrograph of biopsy specimen examined under
polarized light shows fibrosis contains large accumulations of strongly
birefringent dust particles.
|
|
View larger version (110K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 2H —57-year-old man with inhalational talc pneumoconiosis employed in
talc industry for 14 years. Histologic section from area of subpleural line
shows peribronchiolar fibrosis joined by collapse and fibrosis of alveoli
along thickened pleura (arrows). (H and E, x1.6)
|
|
Areas of ground-glass attenuation were defined as areas of hazy high
attenuation that did not obscure the underlying vascular markings. Septal
thickening was defined as short lines in perpendicular contact with the
pleural surface or a pattern of multiple polygonal lines representing
thickened interlobular septa. Subpleural lines were defined as linear areas of
increased attenuation within 1 cm of the pleura and parallel to the inner
chest wall. Small rounded opacities were defined as nodules less than 10 mm in
diameter. Centrilobular nodules were recorded if nodules were identified
around peripheral pulmonary arterial branches or 3-5 mm away from the pleura,
interlobular septa, or pulmonary veins. Small irregular opacities were defined
as intersecting lines that formed a fine or coarse network. Large opacity was
defined as an opacity having a diameter exceeding 10 mm. Traction
bronchiectasis was defined as bronchial dilatation within areas of a
parenchymal abnormality. Honeycombing was defined as an accumulation of cystic
spaces with thickened walls. Lobular low-attenuation areas were defined as
areas of decreased attenuation with a lobular or multilobular distribution
adjacent to areas of high attenuation. Emphysema was characterized by areas of
decreased attenuation, disruption of the vascular pattern, and absence of a
well-defined wall.
For craniocaudal distribution, the upper lung zone was defined as the
region above the tracheal carina; the middle zone as the region between the
carina and inferior pulmonary veins; and the lower zone as the region below
the inferior pulmonary veins. Calcified or noncalcified pleural plaques and
lymph node enlargement with the short axis exceeding 1 cm were also
recorded.
Results
Chest Radiographic Findings
The main abnormality found on initial chest radiographs was small rounded
opacities of the p type (Fig.
1A). All zones usually were affected. In one patient, the
opacities had upper lung zone predominance, and in another middle lung zone
predominance. Small irregular opacities of the s and t types predominated in
the lower lung zones in one patient. The profusion and type of small opacities
are presented in Table 1. Large
opacities greater than 1 cm in diameter were found in seven patients on
initial chest radiographs (Fig.
2A). The large opacities were distributed in the upper lung zones
in two patients, in the middle lung zones in one patient, in the upper and
middle lung zones in three patients, and in all zones in one patient.
Follow-up examinations of two of the 14 patients showed the small opacities
had progressed. Profusion had changed from 2/2 to 2/3. In another patient,
profusion of small opacities decreased from 2/2 to 2/1, but that of large
opacities increased. The other 11 patients had no change during the follow-up
period. The size and number of large opacities had increased by the follow-up
examination in all seven patients (Figs.
1B and
2B). At the followup
examinations of another two patients, large opacities were present in the
upper, middle, and lower zones. Progression of large opacities was found to be
a difference of one grade in four patients (from 0 to A in one and from B to C
in three) and a difference of two grades in one patient (from 0 to B). In
another four patients, progression was within the same grade (from A to A in
two, B to B in one, and C to C in one). In these four patients, progression of
large opacities was found at side-by-side review of the radiographs in
chronologic order. Lymph node enlargement was found in two patients. Pleural
plaques were found in no patients.
Thin-Section CT Findings
The thin-section CT findings for the 14 patients are presented in
Table 2. The main CT finding in
12 of 14 patients was diffusely distributed centrilobular nodules 1-2 mm in
diameter. In one patient, the centrilobular nodules had upper lung
predominance; in another patient, middle lung predominance; and in 10
patients, no zonal predominance. A few welldefined discrete nodules were found
in these 12 patients, mingled with centrilobular nodules in all zones
(Fig. 1C). Well-defined nodules
ranged from 2 to 4 mm in diameter and were in a centrilobular or subpleural
location. In one patient, CT scans showed small irregular opacities and
honeycombing in the lower lung zones and diffusely distributed centrilobular
nodules in all zones. In another patient, CT showed large opacities in the
upper and middle lung zones and a few well-defined small rounded opacities
distributed in all lung zones.
Large opacities greater than 1 cm in diameter were found in nine patients.
The large opacities involved all lung zones in four patients, the upper zones
in one patient, the upper and middle zones in three patients, and the middle
and lower zones in one patient. The large opacities were irregular, round, or
crescent-shaped (Fig. 2C). Most
large opacities were totally of high attenuation
(Fig. 1D).
The other frequent findings included septal lines (n = 10),
subpleural lines (n = 9) (Fig.
3), and ground-glass opacity (n = 8). Emphysema was found
in five patients, and all five of these patients were smokers. Lobular
low-attenuation areas were seen in five patients, and two of these five
patients were nonsmokers. On expiratory CT scans of two patients, air trapping
and low-attenuation areas were delineated more clearly but did not newly
appear elsewhere, and additional areas of low attenuation were not identified.
Septal lines and emphysema were present in all lung zones. Subpleural lines,
groundglass opacity, and lobular low-attenuation areas were present in a
random distribution.
Slight lymph node enlargement of increased attenuation was visible in eight
patients (Fig. 1D).
Noncalcified pleural plaques were seen in three patients and calcified pleural
plaques in four patients. Lymph node enlargement in six of the eight patients
and pleural plaques were not found on chest radiographs
(Table 2).
There was good agreement between observers. In two cases there was
disagreement about chest radiographs and in one case about CT scans.
Radiologic-Pathologic Correlation
The postmortem low-kilovoltage radiographs and thin-section CT scans of one
patient showed a crescent-shaped large opacity, subpleural lines, and small
nodules (Figs. 2D and
2E). The crescent-shaped large
opacity corresponded histologically to diffuse fibrosis with proliferation of
dustladen macrophages and multinucleated giant cells
(Fig. 2F). Microscopic
evaluation with polarized light revealed dense accumulations of birefringent
dust particles in fibrosis (Fig.
2G). The subpleural lines corresponded histologically to
peribronchiolar fibrosis joined by collapse and fibrosis of the alveoli along
the inner chest wall (Fig.
2H).
In six autopsy cases, the lungs exhibited varying degrees of fibrosis.
Nodular fibrosis was adjacent to the vessels or bronchi
(Fig. 4). Dense accumulations
of birefringent dust particles were found in fibrosis and lymph nodes, but
calcification was not found in fibrosis or lymph nodes. Pleural plaques were
found at histopathologic examination in three of six autopsy cases. In these
three cases, the premortem CT scans showed pleural plaques.
Discussion
Three forms of talc pneumoconiosis by inhalation have been described in the
literature: talc asbestosis, talc silicosis, and talcosis. Talc asbestosis is
produced by inhalation of talc with asbestiform fibers. The findings of talc
silicosis caused by talc mined with highsilica-content mineral are identical
to those of silicosis. Talc free of silica and asbestiform minerals may be
fibrogenic [3,
4,
8,
17].
In our cases, the predominant radiographic abnormalities were small nodular
opacities affecting all lung zones. Small irregular opacities were rare.
Although progression of small rounded opacities was rare during long-term
follow-up, most large opacities progressed. Slight pleural plaques and lymph
node enlargement not found on chest radiographs were identified on
thin-section CT scans.
As in patients with silicosis, in our pneumoconiosis patients, small
rounded opacities, septal lines, large opacities, and lymph node enlargement
were predominant findings on CT. The characteristic radiologic abnormality in
silicosis is small, well-circumscribed nodules usually 2-5 mm in diameter and
mainly involving the upper and posterior lung zones
[12,
18]. In our patients, however,
centrilobular nodules were the prominent finding, and the distribution was
diffuse. In silicosis, large opacities usually involve the upper lung zones,
and various types of calcification of large opacities are found, mostly
punctate rather than linear or massive. In our patients, large opacities were
distributed in all lung zones, and large opacities were of high density.
Unlike the findings in patients with silicosis, pleural plaques were seen in
our patients (Table 3). One of
our patients had the CT findings of asbestosis: diffuse linear interstitial
pattern predominantly distributed in the lower zones of the lungs
[12,
19]. Diffusely distributed
centrilobular nodules unlike the findings of asbestosis were found on that
patient's CT scans.
Subpleural curvilinear lines are defined as linear areas of increased
attenuation within 1 cm of the pleura and parallel to the inner chest wall.
The pathologic correlate of subpleural lines represents peribronchiolar
fibrotic thickening combined with flattening and collapse of the alveoli due
to fibrosis in asbestosis [20,
21]. Subpleural curvilinear
lines are considered to be caused by other pathologic processes. This finding
corresponds to conditions such as platelike atelectasis in the
corticomedullary junction of the lung
[22], interstitial edema from
pulmonary congestion [23], and
subpleural lymphatic network after lymphography
[24].
The main CT findings in three patients with inhalational pulmonary talcosis
described by Marchiori and associates
[13] were small centrilobular
and subpleural nodules associated with conglomerated masses containing foci of
high attenuation. Our findings were similar to those of Marchiori et al. In
our study, centrilobular nodules histopathologically corresponded to nodular
fibrosis and deposition of talc particles adjacent to the vessels or bronchi.
Our study revealed that increased CT densities of lymph nodes and large
opacities were caused by large numbers of talc particles.
The radiographic findings of IV administration of talc include large,
irregular, nodular densities or consolidations in the upper parts of the
middle fields of the lungs that may rapidly progress into large masses or
massive consolidations. Widespread irregular nodules also occur
[9-11].
The CT findings in patients with pulmonary talcosis resulting from chronic IV
drug abuse include widespread ground-glass attenuation, a diffuse fine nodular
pattern, and a combination of nodules and lower lobe panacinar emphysema.
Confluent perihilar masses with areas of high attenuation are also seen
[9-11].
The CT findings in our patients resembled those of pulmonary talcosis due to
IV administration. A diffuse fine nodular pattern and large opacities
containing high-attenuation material are seen in both IV administration and
inhalation. Although lobular low-attenuation areas were seen, lower lobe
panacinar emphysema was not seen in our patients. To our knowledge, slight
lymph node enlargement with high-attenuation material has not been reported in
talcosis by IV administration. Talcosis from IV administration of talc can be
differentiated from the inhalation of talc on the basis of histologic findings
and size of the talc particles. The mean particle diameter is far greater in
IV-administrated talc, usually exceeding 10 µm compared with 4 µm for
inhaled talc [25].
We did not analyze the nature of the mineral exposure in our patients, so
it is not clear whether our findings were caused by contaminant fibers. The
composition of commercially available talc is quite variable from region to
region and from industry to industry. Pleural plaques are seen in workers
exposed to talc contaminated with asbestos and talc free of asbestos
[26]. Our study had
limitations. It was retrospective, and the preliminary conclusions were based
on findings in a relatively small number of patients.
In summary, serial chest radiography showed that in talc pneumoconiosis,
large opacities progressed more often than small rounded opacities. CT scans
depicted pleural plaques and lymph node enlargement with high-attenuation
material not identified on chest radiography. The distribution of small
rounded opacities was diffuse, whereas large opacities were present in all
lung zones. Unlike silicosis, in talc pneumoconiosis there was no predilection
for upper lung zones. Pleural plaques and subpleural lines and small rounded
opacities were evident. CT showed high-attenuation material in large opacities
and lymph node enlargement caused by large numbers of talc particles. The CT
findings of talc pneumoconiosis are not specific and can occur in asbestosis
and silicosis. Although the combination of these findings is seen in patients
with mixed dust exposure, talc pneumoconiosis should be considered in patients
with diffusely distributed centrilobular nodules, dense large opacities, dense
lymph nodes, and pleural plaques.
References
- Thorel C. Talc lung: a contribution to the pathological anatomy of
pneumoconiosis. Beitr Pathol Anat Allgem Pathol1896; 20:85
-101
- Vallyathan NV, Craighead JE. Pulmonary pathology in workers exposed
to nonasbestiform talc. Hum Pathol 1981;12
: 28-35[Medline]
- Gibbs AE, Pooley FD, Griffiths DM, Mitha R, Craighead JE, Ruttner
JR. Talc pneumoconiosis: a pathologic and mineralogic study. Hum
Pathol 1992; 23:1344
-1354[CrossRef][Medline]
- Feigin DS. Talc: understanding its manifestations in the chest.
AJR 1986; 146:295
-301[Abstract/Free Full Text]
- Leophonte P, Didier A. French talc pneumoconiosis. In: Bignon J,
ed., Health-related effects of phyllosilicates.
Berlin, Germany: Springer Verlag, 1990:203
-209
- Porro FW, Patton JR, Hobbs AA. Pneumoconiosis in the talc industry.
AJR 1942; 47:507
-524
- Kleinfeld M, Messite J, Tabershaw IR. Talc pneumoconiosis.
AMA Arch Ind Health 1955;12
: 66-72[Medline]
- Feigin DS. Misconceptions regarding the pathogenicity of silicas
and silicates. J Thorac Imaging 1989;4
: 68-80[Medline]
- Padley SP, Adler BD, Staples CA, Miller RR, Müller NL.
Pulmonary talcosis: CT findings in three cases.
Radiology 1993;186
: 125-127[Abstract/Free Full Text]
- Ward S, Heyneman LE, Reittner P, Kazerooni EA, Godwin JD,
Müller NL. Talcosis associated with IV abuse of oral medications: CT
findings. AJR 2000;174
: 789-793[Abstract/Free Full Text]
- Stern EJ, Frank MS, Schutz JF, Glenny RW, Schmidt RA, Godwin JD.
Panlobular pulmonary emphysema caused by IV injection of methylphenidate
(Ritalin): findings on chest radiographs and CT scans.
AJR 1994; 162:555
-560[Abstract/Free Full Text]
- Akira M. High-resolution CT in the evaluation of occupational and
environmental disease. Radiol Clin North Am2002; 40:43
-59[CrossRef][Medline]
- Marchiori E, Souza AS Jr, Müller NL. Inhalational pulmonary
talcosis: high-resolution CT findings in 3 patients. J Thorac
Imaging 2004; 19:41
-44[CrossRef][Medline]
- Guidelines for the use of ILO international
classification of radiographs of pneumoconiosis, rev ed.
Occupational Safety and Health Series no. 22. Geneva, Switzerland:
International Labor Organization, 1980
- Austin JH, Müller NL, Friedman PJ, et al. Glossary of terms
for CT of the lungs: recommendations of the nomenclature committee of the
Fleischner Society. Radiology 1996;200
: 327-331[Free Full Text]
- Im JG, Kim SH, Chung MJ, Koo JM, Han MC. Lobular low attenuation of
the lung parenchyma on CT: evaluation of forty-eight patients. J
Comput Assist Tomogr 1996;20
: 756-762[CrossRef][Medline]
- Lockey JE. Nonasbestos fibrous minerals. Clin Chest
Med 1981; 2:203
-218[Medline]
- Kim KI, Kim CW, Lee MK, et al. Imaging of occupational lung
disease. RadioGraphics 2001;21
: 1371-1391[Abstract/Free Full Text]
- Aberle DR, Gamsu G, Ray CS, Feuerstein IM. Asbestos-related pleural
and parenchymal fibrosis: detection with thin-section CT.
Radiology 1988;166
: 729-734[Abstract/Free Full Text]
- Akira M, Yokoyama K, Yamamoto S, et al. Early asbestosis:
evaluation with high-resolution CT. Radiology1991; 178:409
-416[Abstract/Free Full Text]
- Yoshimura H, Hatakeyama M, Otsuji H, et al. Pulmonary asbestosis:
CT study of subpleural curvilinear shadow. Radiology1986; 158:653
-658[Abstract/Free Full Text]
- Kubota H, Hosoya T, Kato M, Uchimura F, Itagaki T, Yamaguchi K.
Plate-like atelectasis at the corticomedullary junction of the lung: CT
observation and hypothesis. Radiat Med1983; 1:305
-310[Medline]
- Arai K, Takashima T, Matsui O, Kadoya M, Kamimura R. Transient
subpleural curvilinear shadow caused by pulmonary congestion. J
Comput Assist Tomogr 1990;14
: 87-88[Medline]
- Pilate I, Marcelis S, Timmerman H, Beeckman P, Osteaux MJ.
Pulmonary asbestosis: CT study of subpleural curvilinear shadow. (letter)
Radiology 1987;164
: 584[Medline]
- Abraham JL, Brambilla C. Particle size for differentiation between
inhalation and injection pulmonary talcosis. Environ
Res 1980; 21:94
-96[Medline]
- Wegman DH, Peters JM, Boundy MG, Smith TJ. Evaluation of
respiratory effects in miners and millers exposed to talc free of asbestos and
silica. Br J Ind Med 1982;39
: 233-238[Medline]
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Top
Abstract
Introduction
