Imaging |

Computed Tomography Findings of Isolated Anthracosis: An Analysis of 58 Proved Cases FREE TO VIEW

Shahram Kahkouee, MD; Ramin Pourghorban, MD; Mahdi Bitarafan, MD; Sandbad Armand, MD; Leila Mosadegh, MD
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Department of Radiology, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran

Chest. 2013;144(4_MeetingAbstracts):592A. doi:10.1378/chest.1687096
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SESSION TITLE: Imaging Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Bronchial anthracosis is defined as black tattoos in mucosal layer possibly due to dust exposure or air pollution. It usually results in bronchial narrowing or obstruction in elderly Asians; thus, may mimic bronchogenic carcinoma. Causative association between anthracofibrosis and tuberculosis is also an issue of ongoing debate and their imaging findings may interfere with each other. The current study sought to describe the imaging findings in proved anthracosis with no apparent accompanying disease, which in turn could have its own interfering manifestations.

METHODS: 111 patients with proved anthracosis, based on findings in bronchial biopsy specimens, were enrolled from January 2007 to March 2012. After excluding those with tuberculosis, malignancy, smoking-related lung diseases and chronic bronchitis, computed tomography (CT) findings of the remaining 58 patients (female, 29; mean age, 70.2; smoker, 12); designated as isolated anthracosis, were evaluated. All examinations were performed with a 4-detector row scanner and helical CT scans were obtained at 5-mm collimation with a helical pitch of 3, 5-mm image intervals, 120 kV and 160 mAs. Imaging features were reviewed by two expert radiologists in chest imaging, with consensus.

RESULTS: We highlighted central peribronchial soft tissue thickening (63.8%) as an important imaging finding, causing bronchial narrowing (63.8%) or obstruction (19%). Bronchial narrowing affected multiple bronchi in some cases (two bronchi, 12 patients; three bronchi, 9 patients; five bronchi, 2 patients). As a result, segmental atelectasis (46.6%), lobar (22.4%) or multilobar (3.4%) collapses were ensued. Mentioned findings mostly occurred in the right lung, with a predominance of right middle lobe (RML). Air trapping, mosaicism and some other nonspecific findings like scattered parenchymal nodules, nodular infiltration and calcified or non-calcified lymph nodes were also appreciated.

CONCLUSIONS: Although bronchial narrowing and peribronchial soft tissue thickening may raise the suspicion of malignancy in elderly patients; the diagnosis of anthracosis may also be considered, especially in non-smokers when multiple bronchial involvement and other related imaging findings are accompanied by black pigmentation of the bronchial mucosa visualized at bronchoscopy.

CLINICAL IMPLICATIONS: Familiarity with the CT findings of anthracosis will help to reach the correct diagnosis in the appropriate clinical settings.

DISCLOSURE: The following authors have nothing to disclose: Shahram Kahkouee, Ramin Pourghorban, Mahdi Bitarafan, Sandbad Armand, Leila Mosadegh

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