Study: Silicosis Missed in Early Diagnoses
CHICAGO — Another research study, this time from the Radiological Society of North America (RSNA), links countertop workers and silicosis and calls for more vigilance in early diagnosis.
“Resurgence of an Epidemic: Crippling Silicosis in Engineered Countertop Workers – A Pilot Single Institutional Cross-Sectional Study” made the list of presentations at the RSNA’s annual conference earlier this month.
“This is a new and emerging epidemic, and we must increase awareness of this disease process so we can avoid delays in diagnosis and treatment for our patients,” said the study’s lead author Sundus Lateef, M.D., diagnostic radiology resident at the University of California in Los Angeles (UCLA).
For the study, Dr. Lateef and colleagues studied the imaging features of silicosis at a large urban safety-net hospital outside of Los Angeles with few historic cases of the disease. The study group included 55 engineered stone countertop workers diagnosed with silicosis using available CT and pulmonary function tests.
In a preliminary analysis of 21 workers, 100% were male and Hispanic with median age of 43 years and a median exposure of 18 years. All patients were symptomatic. Patients commonly had atypical and advanced features of silicosis. Shortness of breath and cough were the most common symptoms.
Primary clinicians recognized silicosis at the initial encounter in only four of 21 cases (19%), while radiologists recognized it in seven of 21 cases (33%). Alternative diagnoses, such as infection, were initially suggested in most cases. Nearly half of the patients (48%) had atypical imaging features.
“Silicosis may present with atypical features that may catch radiologists off guard in practice regions where silicosis is not traditionally diagnosed, which can lead to delays in diagnosis,” Dr. Lateef said.
The study pointed to a need for more awareness and better recognition of imaging features associated with silicosis.
“These new cases of silicosis demonstrate radiology findings different from the historical disease, and doctors may not be aware of the diagnosis when they see these images,” Dr. Lateef said.
“There is a critical lack of recognition of exposure and screening for workers in the engineered stone manufacturing industry,” Dr. Lateef said. “There needs to be a push for earlier screening and advocacy for this vulnerable population, which in our case were Spanish-speaking immigrant workers.”
As part of an effort to improve screening and advocacy for workers, Dr. Lateef and colleagues are working on the ongoing California Artificial Stone and Silicosis (CASS) Project. The project aims to promote respiratory health among vulnerable workers in the state’s countertop fabrication industry.
Co-authors are Andrea Oh, M.D., Jonathan Hero Chung, M.D., Jane Fazio, M.D., Nader Kamangar, M.D., M.S., Sheiphali Gandhi, M.D., M.P.H., Robert J. Tallaksen, M.D., and
RSNA, based in Oak Brook, Ill., is an association of radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation.
