Halldin Cara N, Blackley David J, Markle Travis, Cohen Robert A, Laney A Scott
Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.
The Division of Environmental and Occupational Health Sciences School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
Arch Environ Occup Health. 2020;75(3):152-158. doi: 10.1080/19338244.2019.1593099. Epub 2019 May 20.
Clinical teaching generally asserts that large opacities of progressive massive fibrosis (PMF) on chest radiographs present primarily bilaterally in the upper lung zones, and with an elevated background profusion of small opacities. However, the contemporary basis for these descriptions is limited.Radiographs taken for the Coal Workers' Health Surveillance Program during 2000-2015 and previously determined to have large opacities ("PMF radiographs", = 204), and a random sample previously deemed free of large opacities ( =22), were independently reevaluated by three National Institute for Occupational Safety and Health (NIOSH) B Readers. Large opacities were noted primarily in the upper right (41%) or upper left (28%) lung zone, but 31% were in middle or lower zones. Unilateral involvement was observed in 34% of readings, with right lung predominance (82%). The median small opacity profusion category for the radiographs with PMF was 2/1. The number of large opacities was not correlated with small opacity profusion category. The "classic" descriptions of PMF as bilateral, associated with elevated background profusions of small pneumoconiotic opacities, were each absent in a third of miners.
临床教学通常认为，胸部X光片上的进行性大块纤维化（PMF）大阴影主要双侧出现在肺上叶区域，且伴有小阴影背景密集度升高。然而，这些描述的当代依据有限。对2000 - 2015年期间为煤矿工人健康监测项目拍摄且之前已确定有大阴影的X光片（“PMFX光片”，n = 204），以及之前认为无大阴影的随机样本（n = 22），由三位美国国家职业安全与健康研究所（NIOSH）的B级阅片者进行独立重新评估。大阴影主要见于右上肺区（41%）或左上肺区（28%），但31%位于中肺或下肺区。34%的阅片中观察到单侧受累，以右肺为主（82%）。有PMF的X光片的小阴影密集度中位数类别为2/1。大阴影数量与小阴影密集度类别无关。三分之一的矿工中，均不存在将PMF描述为双侧且伴有小尘肺阴影背景密集度升高的“经典”情况。
