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BACKGROUND: The impressive association of lung involvement and gastroesophageal reflux in scleroderma raises the possibility of a cause-effect relationship. OBJECTIVES: To determine clinical, radiological and histopathological features of systemic sclerosis (SSc) patients according the presence or absence of centrilobular fibrosis (CLF). METHODS: Twenty-eight SSc patients with lung involvement were submitted to open lung biopsy and the specimens classified for the presence of CLF (bronchocentric distribution of the lesions and intraluminal matter according to the classification of idiopathic interstitial pneumonia). HRCT, pulmonary function tests and esophageal analysis were also performed. Subsequently, cyclophosphamide was introduced for the nonspecific interstitial pneumonia subgroup and antireflux treatment was intensified for isolated CLF patients. RESULTS: Isolated CLF was found in 21% of the biopsies and also found associated to nonspecific interstitial pneumonia in 84% of these patients. The other 3 cases had usual interstitial pneumonia, pulmonary hypertension and respiratory bronchiolitis-associated interstitial lung disease. The histopathological analysis revealed that all 6 patients with isolated CLF had the bronchocentric distribution and intraluminal basophilic content, with foreign bodies detected in one third of them. The central distribution of lung involvement on HRCT was found in 67% of these patients with a consistent patchy distribution (100%). Ground glass (67%) and consolidation (33%) were the predominant patterns found. The constant clinical finding in all isolated CLF cases was dyspnea, esophageal abnormalities and a moderate lung impairment (FVC: 63.83 +/- 16.31%; DLCO: 61.66 +/- 18.84%). Lung function parameters in isolated CLF patients remained stable after 1 year of exclusively intensive antireflux treatment (FVC, p = 0.23; DLCO, p = 0.59). CONCLUSIONS: The novel description of CLF pattern in SSc lung disease with peculiar histological, tomographic and clinical features will certainly contribute to a more appropriate therapeutic approach.

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A presente revisão apresenta as características radiográficas e tomográficas das principais doenças ocupacionais respiratórias (silicose e asbestose). Em especial, enfatiza-se a relevância prática da tomografia computadorizada de alta resolução, método mais sensível e específico para a detecção e quantificação da extensão das lesões pleuroparenquimatosas a elas relacionadas.

This chapter consists of a review of the literature regarding radiographic and tomographic characteristics of the principal occupational respiratory diseases (silicosis and asbestosis). Special attention is given to the practical relevance of high-resolution computed tomography, which is the most sensitive and specific method of identifying and quantifying the extent of pleural and parenchymal lesions related to such diseases.

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OBJECTIVE: To assess the reproducibility of a new high-resolution computed tomography (CT) visual semiquantitative method for pleural plaques in asbestos-exposed workers. MATERIAL AND METHODS: We performed thin-section CT in 752 chrysotile asbestos mining workers and ex-workers. Institutional review board approval and signed written informed consent from subjects were obtained. Two readers independently evaluated the 752 CT scans and identified 57 workers (mean age +/- SD, 61.8 years +/- 8.1; range, 37 to 81 years) who had pleural plaques and no other pleural or parenchymal abnormality. Three independent radiologists then quantified the plaque burden in these 57 workers using a scoring system based on the evaluation of the maximum thickness of parietal pleural plaques and percentage of parietal pleural surface involvement. We also calculated the proportion between the number of CT slices with diaphragmatic plaques and the total number of slices in which the diaphragm was seen (pdiaph). The intraobserver and interobserver agreements were analyzed using weighted Kappa coefficient. RESULTS: Interobserver agreements were good for the pleural plaque score (k = 0.61, 0.75, and 0.79) and ranged from good (k = 0.61) to excellent (k = 0.86) for the pdiaph. Intraobserver agreements ranged from good to excellent for the pleural plaque score (k = 0.79 and 1.00) and for the pdiaph (k = 0.79 and 0.93). CONCLUSION: The method proposed for high-resolution CT pleural plaque quantification in asbestos-exposed workers has a high reproducibility.

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This chapter consists of a review of the literature regarding radiographic and tomographic characteristics of the principal occupational respiratory diseases (silicosis and asbestosis). Special attention is given to the practical relevance of high-resolution computed tomography, which is the most sensitive and specific method of identifying and quantifying the extent of pleural and parenchymal lesions related to such diseases.

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A sarcoidose é uma doença sistêmica de causa indeterminada, caracterizada por granulomas não-caseosos. Embora possa afetar qualquer órgão, esta doença tem sua morbi-mortalidade relacionada principalmente ao acometimento pulmonar, presente em 80 por cento a 90 por cento dos pacientes. Este artigo ilustra as principais manifestações pulmonares da sarcoidose na tomografia computadorizada de alta resolução, incluindo as formas típicas e atípicas.

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OBJECTIVE: To assess high-resolution computed tomography (HRCT) findings in silicosis and to better define the role of HRCT in early detection of parenchymal abnormalities in silica-exposed workers. METHODS: Forty-one stone carvers were evaluated with chest radiographs (CR), HRCT, and pulmonary function tests (PFT). Inter-reader agreement was calculated using the kappa statistic (k). Correlation between radiographic and HRCT profusion scores and PFT was assessed using the Spearman correlation coefficient. RESULTS: The most common HRCT findings were branching centrilobular structures, seen in 28/41 workers (68.3%). Nodules consistent with silicosis were detected in 53.7% workers on CR and in 56.1% workers on HRCT. Inter-reader agreement for diagnosis of silicosis was better on HRCT (k = 0.84) than on CR (k = 0.54). Small opacity profusion on HRCT correlated inversely with total lung capacity and FVC%. CONCLUSION: Profusion of opacities on HRCT correlates with functional impairment. The presence of branching centrilobular structures may be helpful in early recognition of silicosis.

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Several aspects of the pathogenesis of paracoccidioidomycosis (PCM) have not yet been fully clarified. We describe a patient with an overwhelmingly acute form of PCM who presented with clinically apparent pulmonary infection that spontaneously subsided while yeast cells disseminated systemically. This case may help to explain the paradox of the absence of pulmonary involvement in the acute disseminated form of PCM.

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INTRODUÇAO: A dispnéia é um sintoma de difícil avaliação, principalmente nas doenças ocupacionais. OBJETIVO: Avaliar a relação entre presença e intensidade de dispnéia crônica, e sua repercussão funcional em ex-trabalhadores com asbestose na avaliação de disfunção e incapacidade. MÉTODO: Escores de dispnéia pelas escalas Medical Research Council modificada, American Medical Association de 1984 e 1993 e Baseline Dyspnea Index foram obtidos em 40 ex-trabalhadores com diagnóstico de asbestose, os quais foram também submetidos a espirometria, medidas da capacidade de difusão pulmonar do monóxido de carbono e testes de exercício cardiopulmonar incremental e submáximo. RESULTADO: Dispnéia esteve presente em 72,5 por cento e 67,5 por cento dos indíviduos de acordo com as escalas do Medical Research Council e American Medical Association de 1984, respectivamente e em apenas 37,5 por cento e 31,6 por cento dos pacientes de acordo com as escalas American Medical Association de 1.993 e Baseline Dyspnea Index. Houve melhor concordância entre as escalas Medical Research Council e American Medical Association de 1993, e American Medical Association de 1984 e American Medical Association de 1993 quando as graduações "ausente" e "leve" foram agrupadas. Não foi observada relação significativa entre dispnéia de acordo com cada uma das escalas e presença de anormalidades funcionais no repouso e/ou exercício. CONCLUSAO: O nível de concordância entre as escalas de dispnéia varia significativamente em indivíduos com asbestose. Há falta de relação dos índices de dispnéia com variáveis que avaliam disfunção respiratória em repouso e exercício.

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PURPOSE: To evaluate the relationship between abnormalities at thin-section computed tomography (CT) and indexes of pulmonary gas exchange impairment at rest and during moderate exercise in workers exposed to asbestos. MATERIALS AND METHODS: Eighty-two workers with long-term exposure to asbestos and abnormal thin-section CT findings underwent respiratory physiologic measurements at rest (lung diffusing capacity, Dlco) and during exercise (oxygen uptake-corrected alveolar-arterial pressure difference for oxygen, DeltaP[A-a]O(2)/VO(2)). CT results were compared with physiologic measurements of impairment in gas exchange (Dlco < 70% predicted value and/or DeltaP[A-a]O(2)/VO(2) > 20 mm Hg. L. min(-1)). The CT findings were divided into five categories by using a previously described method. Odds ratios and 95% CIs for gas exchange defects were calculated for patients grouped according to CT findings. Logistic regression analysis was performed with gas exchange as the dependent response and CT abnormalities as independent variables. RESULTS: A significant association was found between extent of disease at CT and impairment of gas exchange (P <.01). Probability of functional impairment was increased with multifocal (class II) and diffuse (class III) CT abnormalities, particularly when several lesion types were found concomitantly. Logistic regression analysis demonstrated significant association of parenchymal bands (odds ratio, 6.20; 95% CI: 1.99, 19.22) and subpleural nodules (odds ratio, 3.83; 95% CI: 1.23, 11.89) with functional impairment. Presence and number of pleural plaques did not improve model accuracy for gas exchange impairment prediction (P >.05). CONCLUSION: Thin-section CT grading of interstitial lung disease is useful in assessing the likelihood of pulmonary gas exchange impairment at rest (Dlco) and during exercise (DeltaP[A-a]O(2)/VO(2)) in workers with long-term asbestos exposure.

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During the anhepatic phase of conventional liver transplantation (LT), the inferior vena cava (IVC) is cross-clamped and venovenous bypass (VVB) is usually indicated for diversion of IVC and portal blood flow. VVB can theoretically lead to pulmonary complications due to the contact of the blood with the surfaces of the circuit. In the piggyback method, preservation of the IVC avoids VVB. The aim of this study is to compare pulmonary alterations after conventional with VVB versus piggyback LT. Sixty-seven patients were randomized for conventional VVB (n = 34) or piggyback (n = 33) LT. Pulmonary static compliance (C(st)) and Pa(O2)/F(IO2) ratio were measured pre- and post-LT. Chest X-rays were obtained daily from the 1st to the 5th postoperative day. Pre- and post-LT C(st) were 73.4 +/- 36.0 mL/cm H(2)O and 59.7 +/- 22.0 mL/cm H(2)O in the conventional group and 69.1 +/- 20.0 mL/cm H(2)O and 58.7 +/- 27.1 mL/cmH(2)O in the piggyback group. The difference between the two groups was not significant (P =.702). C(st) significantly decreased after LT (P =.008). The pre- and post-LT Pa(O2)/F(IO2) were 455.6 +/- 126.6 mm Hg and 463.1 +/- 105.9 mm Hg in the conventional group and 468.9 +/- 114.1 mm Hg and 483.3 +/- 119.8 mm Hg in the piggyback group. The difference among the two groups was not significant (P = 0.331). There was no significant difference after LT (P =.382). Upon the radiological evaluation, piggyback group presented a higher frequency of pulmonary infiltrates (80.6% vs. 50.0%; P =.025). In conclusion, piggyback LT recipients have a higher rate of pulmonary infiltrates when compared to those operated upon using the conventional VVB method.

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BACKGROUND: In the city of Petrópolis, Brazil, artisans carve souvenirs from a variety of silica-containing minerals. The finding of pulmonary massive fibrosis in one of the workers motivated an investigation of the prevalence of silicosis in this group. METHODS: Between January 2000 and June 2002, a cross-sectional study was performed. We obtained clinical and occupational histories, spirometry, lung volumes, and carbon monoxide diffusion capacity measurements. Chest radiographs and high-resolution computed tomographies (HRCT) were evaluated. Personal air samples were analyzed. RESULTS: Forty-two stone carvers were examined. The prevalence of silicosis was 53.7%. HRCT better characterized silicotic lesions compared to chest radiographs. Early coalescence of small opacities was associated with lung function impairment. The concentration of dust exceeded permissible limits in 91% of the workplaces. CONCLUSIONS: Exposure to high levels of silica dust was associated with an increased prevalence of silicosis among stone carvers. Am. J. Ind. Med. 45:194-201, 2004.

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INTRODUÇÄO: A radiografia de tórax (RX) ainda é, no dias atuais, o principal método de diagnóstico da silicose, seguindo-se as normas da Organizaçäo Internacional do Trabalho (OIT). A interpretaçäo radiológica de casos iniciais é dificil, podendo ocorrer divergências mesmo entre leitores experientes. Recentemente, tem sido considerada a possibilidade de utilizaçäo da tomografia computadorizada com técnica de alta resoluçäo (TCAR) para avaliaçäo de casos incipientes. RESULTADOS E CONCLUSÄO: Houve boa concordância entre os métodos quanto à classificaçäo na categoria 0, ou seja, os dois métodos mostraram-se equivalentes para eezcluir o diagnóstico de silicose. Porém, para o diagnóstico da doença, caracterizado por classificaçäo na categoria 1 ou superior, näo foi obtida boa concordância entre os métodos.

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OBJECTIVE: The aims of this study were to evaluate the role of high resolution computed tomography of the torax in detecting abnormalities in chronic asthmatic patients and to determine the behavior of these lesions after at least one year. METHOD: Fourteen persistent asthmatic patients with a mean forced expiratory volume in 1-second that was 63 percent of predicted and a mean forced expiratory volume in 1-second /forced vital capacity of 60 percent had two high resolution computed tomographys separated by an interval of at least one year. RESULTS: All 14 patients had abnormalities on both scans. The most common abnormality was bronchial wall thickening, which was present in all patients on both computed tomographys. Bronchiectasis was suggested on the first computed tomography in 5 of the 14 (36 percent) patients, but on follow-up, the bronchial dilatation had disappeared in 2 and diminished in a third. Only one patient had any emphysematous changes; a minimal persistent area of paraseptal emphysema was present on both scans. In 3 patients, a "mosaic" appearance was observed on the first scan, and this persisted on the follow-up computed tomography. Two patients had persistent areas of mucoid impaction. In a third patient, mucus plugging was detected only on the second computed tomography. CONCLUSIONS: We conclude that there are many abnormalities on the high resolution computed tomography of patients with persistent asthma. Changes suggestive of bronchiectasis, namely bronchial dilatation, frequently resolve spontaneously. Therefore, the diagnosis of bronchiectasis by high resolution computed tomography in asthmatic patients must be made with caution, since bronchial dilatation can be reversible or can represent false dilatation. Nonsmoking chronic asthmatic subjects in this study had no evidence of centrilobular or panacinar emphysema

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