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Chemical Worker's Lung Workup

  • Author: Shakeel Amanullah, MD; Chief Editor: Ryland P Byrd, Jr, MD  more...
 
Updated: Jan 14, 2015
 

Imaging Studies

Chest radiography (posteroanterior and lateral) is the first-line imaging modality to help diagnose chemical worker's lung.

A regular helical chest CT scan is not helpful if results of the chest radiograph are normal. Contrast-enhanced chest CT scans may help to better delineate the various hilar/mediastinal lymph nodes.

High-resolution CT scan may show ground-glass infiltrates or other abnormalities that are not visualized on chest radiography.

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Other Tests

Pulmonary function testing should include spirometry, lung volumes, and diffusing capacity of the lungs for carbon monoxide (DLCO). Findings may include obstructive and restrictive lung indices. With disease progression, DLCO values will decline.

Pulmonary physiological testing may be included in the monitoring of disease progression. These tests may include the 6-minute walk test and cardiopulmonary exercise testing.

Other testing may include echocardiogram, right heart catheterization, and sampling of pleural effusion.

Serial medical examinations, pulmonary function tests (including DLCO), and imaging (chest radiography) may be useful to diagnose chemical worker's lung early in its course.

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Procedures

Flexible bronchoscopy with or without bronchoalveolar lavage (BAL), endobronchial biopsies, endobronchial brushing, transbronchial biopsies, and transbronchial needle aspiration and histology can be helpful.

Video-assisted thoracoscopy (VATS) is rarely used for larger lung tissue sampling.

Open lung biopsies are rarely necessary, although they may be useful if the aforementioned tests do not help confirm a diagnosis.

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Histologic Findings

Data are limited. Expected findings are nonspecific and are probably related to the length of exposure and the specific substance involved.

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Staging

A published staging system is not available. Differentiating between nodular and infiltrative lung disease may be useful.

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Contributor Information and Disclosures
Author

Shakeel Amanullah, MD Consulting Physician, Pulmonary, Critical Care, and Sleep Medicine, Lancaster General Hospital

Shakeel Amanullah, MD is a member of the following medical societies: American College of Chest Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Ryland P Byrd, Jr, MD Professor of Medicine, Division of Pulmonary Disease and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University

Ryland P Byrd, Jr, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital

Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, World Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Gilbert E D'Alonzo Jr, DO Director of New Drug Development Center, Fellowship Director, Professor, Department of Medicine, Division of Pulmonary Diseases, Temple University School of Medicine

Disclosure: Nothing to disclose.

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