Radiologic Features of World Trade Center-Related Sarcoidosis in Exposed NYC Fire Department Rescue Workers

Details

• Personal Author:
  Girvin F ; Gupta D ; Liu Y ; Naidich DP ; Prezant DJ ; Schwartz T ; Weiden MD ; Zeig-Owens R ; Girvin F ; Gupta D ; Liu Y ; Naidich DP ; Prezant DJ ; Schwartz T ; Weiden MD ; Zeig-Owens R
• Description:
  Purpose: An increased incidence of sarcoidosis has been demonstrated in firefighters, supporting the concern that occupational/environmental exposure may pose an etiologic risk factor. This incidence increased further after September 11, 2001 following exposure to World Trade Center (WTC) dust and gases. We review computed tomography (CT) features in this population, comparing the range of findings and physiological correlates with those typically reported in unexposed individuals with pulmonary sarcoidosis. Materials and Methods: With CT imaging we retrospectively identified 46 patients with WTC-related sarcoidosis, between March 18, 2002 and April 5, 2014. Scans were independently reviewed by 2 dedicated thoracic radiologists and assessed for disease patterns and correlation with pulmonary functions. Results: The majority (37/46; 80%) had symmetric mediastinal and hilar lymphadenopathy. Similarly, most (38/46; 83%) had perilymphatic nodules. Foci of ill-defined ground glass attenuation were present in 6 (13%). Coalescent nodularity was present in 15 (33%). Only 3 (7%) had parenchymal reticulation. A mixed pattern of lung findings was present in 21 (46%). When all forms of parenchymal disease were scored by zonal distribution, 21 (46%) had parenchymal disease predominantly involving mid and upper lungs; 11/46 (24%) had a random distribution without zonal predominance; 6/46 (13%) demonstrated atypical lower zone predominance. Whereas 15/46 (33%) had obstructive airways disease on pulmonary function tests, there were no CT findings that were predictive of obstructive airways disease. Conclusions: The majority of cases of WTC-related sarcoidosis demonstrated typical radiographic appearances of sarcoidosis, with symmetric hilar and mediastinal lymphadenopathy and mid to upper lung perilymphatic nodules; these findings were consistent with other previously reported cases of sarcoid-like granulomatous disease in association with various alternate underlying etiologies. There was no correlation between disease patterns or extent on CT and pulmonary function testing, likely at least in part due to the overall mild extent of disease in this population. [Description provided by NIOSH]
• Subjects:
  Diagnosis Dust Emergency Responders Environmental Exposure Firefighters Lung Diseases Men Occupational Health Radiation Respiratory Tract Diseases Risk Assessment Risk Factors Safety September 11 Terrorist Attacks Women Workplace

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• Keywords:
  Author Keywords: Sarcoidosis Diagnostic Tests Disaster Sites Dust Exposure Dusts Environmental Exposure Etiology Exposure Levels Fire Fighters Gases Humans Pulmonary System Disorders Radiologists Radiology Rescue Workers Respiratory System Disorders Risk Factors Sarcoid-like Reaction Sarcoidosis Work Environment Workers World Trade Center WTC

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• ISSN:
  0883-5993
• Document Type:
  Text
• Funding:
  Contract ; Cooperative Agreement
• Genre:
  Journal Article ; Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH) ; National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health ; Workplace Safety & Health
• Location:
  North America ; North America
• Pages in Document:
  296-303
• Volume:
  31
• Issue:
  5
• NIOSHTIC Number:
  nn:20050876
• Citation:
  J Thorac Imaging 2016 Sep; 31(5):296-303
• Contact Point Address:
  Francis Girvin, MD, Department of Radiology, Center for Biologic Imaging, NYU-Langone Medical Center, 660 1st Avenue, New York, NY 10016
• Email:
  francis.girvin@nyumc.org
• Federal Fiscal Year:
  2016
• Performing Organization:
  New York City Fire Department
• Peer Reviewed:
  True
• Start Date:
  20110701
• Source Full Name:
  Journal of Thoracic Imaging
• End Date:
  20170331
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:258877383fd2d67827422a74c025bf5dc1a6de4b29ee670c8a439d9562085e9b74868a93109f0f1ce3af1d8311afa04ad9d4edf791bd32c25142f919c1116326
• Download URL:
  https://stacks.cdc.gov/view/cdc/211069/cdc_211069_DS1.pdf
• File Type:
  [PDF - 554.39 KB ]