Chemical Worker's Lung Workup
- Author: Shakeel Amanullah, MD; Chief Editor: Ryland P Byrd, Jr, MD more...
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.
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.
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.
Data are limited. Expected findings are nonspecific and are probably related to the length of exposure and the specific substance involved.
A published staging system is not available. Differentiating between nodular and infiltrative lung disease may be useful.
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