Chest radiography primarily excludes alternative or complicating diagnoses, such as infectious pneumonia or pulmonary edema, with HRCT providing the best imaging characterization of airway disease. CT Chest Hypersensitivity pneumonitis typically presents with a combination of pneumonitis and small airway obstruction, producing characteristic findings on chest HRCT with expiratory imaging [76,77]. New and changing occupational exposures causing hypersensitivity pneumonitis are continually described, highlighting the importance of high clinical suspicion and evaluation with HRCT [33,78,79]. Imaging features of hypersensitivity pneumonitis on HRCT also provide predictive information regarding disease behavior [68,80-90] and drive treatment decisions [91]. Certain occupational inhalational exposures, such as diacetyl acetate and carbon dust, may lead to more isolated airway disease, such as constrictive bronchiolitis, bronchial anthracofibrosis, and occupational asthma. Various occupations, such as flavoring microwave popcorn, processing coffee, and serving on military deployment to Iraq/Afghanistan, can result in constrictive bronchiolitis [29-31] evident on HRCT with expiratory imaging [92]. Of note, a few studies over time have demonstrated the importance of tissue biopsy in the setting of negative HRCT but clinically suspected occupational small airway disease [30,93]. In large airway disease, CT may assist in certain diagnoses, such as isolated bronchial anthracofibrosis [35,93,94], although medical imaging has limited value in occupational asthma outside of diagnosing alternative disease. CT with IV contrast serves no purpose in the setting of suspected occupational airway disease. MRI Chest No specific studies have examined the use of MRI in the setting of occupation-associated airway disease.
Occupational Lung Diseases PCAs. Chest radiography primarily excludes alternative or complicating diagnoses, such as infectious pneumonia or pulmonary edema, with HRCT providing the best imaging characterization of airway disease. CT Chest Hypersensitivity pneumonitis typically presents with a combination of pneumonitis and small airway obstruction, producing characteristic findings on chest HRCT with expiratory imaging [76,77]. New and changing occupational exposures causing hypersensitivity pneumonitis are continually described, highlighting the importance of high clinical suspicion and evaluation with HRCT [33,78,79]. Imaging features of hypersensitivity pneumonitis on HRCT also provide predictive information regarding disease behavior [68,80-90] and drive treatment decisions [91]. Certain occupational inhalational exposures, such as diacetyl acetate and carbon dust, may lead to more isolated airway disease, such as constrictive bronchiolitis, bronchial anthracofibrosis, and occupational asthma. Various occupations, such as flavoring microwave popcorn, processing coffee, and serving on military deployment to Iraq/Afghanistan, can result in constrictive bronchiolitis [29-31] evident on HRCT with expiratory imaging [92]. Of note, a few studies over time have demonstrated the importance of tissue biopsy in the setting of negative HRCT but clinically suspected occupational small airway disease [30,93]. In large airway disease, CT may assist in certain diagnoses, such as isolated bronchial anthracofibrosis [35,93,94], although medical imaging has limited value in occupational asthma outside of diagnosing alternative disease. CT with IV contrast serves no purpose in the setting of suspected occupational airway disease. MRI Chest No specific studies have examined the use of MRI in the setting of occupation-associated airway disease.