Clinical and radiological criteria for the differential diagnosis between asbestosis and idiopathic pulmonary fibrosis: Application in two cases

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Angela Stufano
Arnaldo Scardapane
Maria Pia Foschino Barbaro
Leonardo Soleo
Massimo Corradi
Piero Lovreglio


Asbestosis; Idiopathic pulmonary fibrosis; differential diagnosis


Introduction: Idiopathic pulmonary fibrosis (IPF) and asbestosis are pulmonary interstitial diseases that may present overlapping clinical aspects in the full-blown phase of the disease. For both clinical entities the gold standard for diagnosis is histological examination, but its execution poses ethical problems, especially when performed for preventive or forensic purposes. Objective: To evaluate the application of internationally accepted clinical, anamnestic and radiological criteria for differential diagnosis between asbestosis and IPF, and to assess the ability to discriminate between the two diseases. Even if clinically similar, the two diseases present extremely different prognostic and therapeutic perspectives. Methods: Two clinical cases of IPF are reported, in which the differential diagnosis was made by studying occupational exposure to asbestos, the onset and progression of clinical symptoms, and the identification of specific radiological elements by means of chest High Resolution Computed Tomography (HRCT). Results: The diagnosis of IPF could be made on the basis of the absence of significant exposure to asbestos, the early onset and rapid progression of dyspnea and restrictive ventilatory defects, in association with a pulmonary radiological pattern characterized by peculiar elements such as honeycombing. Discussion: The diagnostic procedure adopted to make a differential diagnosis with asbestosis provides practical clinical elements facilitating the differentiation between the two forms of pulmonary fibrosis, a fundamental aspect of the activity of the occupational physician.


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1. Kim HJ, Perlman D, Tomic R: Natural history of idiopathic pulmonary fibrosis. Respir Med 2015; 109: 661-670
2. Travis WD, Costabel U, Hansell DM, et al: An official American Thoracic Society/European Respiratory Society Statement: Update of the International Multidisciplinary Classification of the Idiopathic Interstitial Pneumonias. Am J Respir Crit Care Med 2013; 188: 733-748
3. Travis WD, Hunninghake G, King TE Jr, et al: Idiopathic nonspecific interstitial pneumonia: report of an American Thoracic Society project. Am J Respir Crit Care Med 2008; 177: 1338-1347
4. Trethewey SP, Walters GI: The Role of Occupational and Environmental Exposures in Pathogenesis of Idiopathic Pulmonary Fibrosis: A Narrative Literature Review. Medicina 2018; 54: 108
5. Apostoli P, Boffetta P, Bovenzi M, et al: Società Italiana di Medicina del Lavoro: Position Paper Amianto. Med Lav 2019; 110: 459-485
6. Ferrante P: Asbestosis and silicosis hospitalizations in Italy (2001-2015): results from the National Hospital Discharge Registry. Eur J Public Health 2019; 29: 876-882
7. Raghu G, Remy-Jardin M, Myers JL et al: Diagnosis of idiopathic pulmonary fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2018; 198: c44-c68
8. Tossavainen A (reporter): Asbestos, asbestosis, and cancer, the Helsinki criteria for diagnosis and attribution 2014: recommendations. Scand J Work Environ Health 2015; 41: 5-15
9. Roggli VL, Gibbs AR, Attanoos R, et al: Pathology of Asbestosis - An Update of the Diagnostic Criteria: Report of the Asbestosis Committee of the College of American Pathologists and Pulmonary Pathology Society. Arch Pathol Lab Med 2010; 134: 462-480
10. Lynch DA, Sverzellati N, Travis WD, et al: Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. Lancet Respir Med 2018; 6: 138-153
11. Decreto legislativo 9 aprile 2008, n. 81 (Rev gennaio 2020):
12. Legge 27 marzo 1992, n. 257: Norme relative alla cessazione dell'impiego dell'amianto. (GU n.87 del 13-4-1992 - Suppl. Ordinario n. 64)
13. Copley SJ, Wells AU, Sivakumaran P, et al: Asbestosis and idiopathic pulmonary fibrosis: comparison of thin-section CT features. Radiology 2003; 229: 731-736
14. Akira M., Yamamoto S, Inoue Y, Sakatani M: High-resolution CT in the evaluation of occupational and environmental disease. Radiol Clin North Am 2002; 40: 43-59
15. Cha YK, Kim JS, Kim Y, Kim YK: Radiologic Diagnosis of Asbestosis in Korea. Korean J Radiol 2016; 17: 674-683
16. King TE Jr, Tooze JA, Schwarz MI, et al: Predicting survival in idiopathic pulmonary fibrosis: scoring system and survival model. Am J Respir Crit Care Med 2001; 164: 1171-1181
17. Wuyts WA, Cavazza A, Rossi G, et al: Differential Diagnosis of Usual Interstitial Pneumonia: When Is It Truly Idiopathic? Eur Respir Rev 2014; 23: 308-319
18. Attanoos RL, Alchami FS, Pooley FD: Usual interstizial pneumonia in asbestos-exposed cohorts – concurrent idiopathic pulmonary fibrosis or atypical asbestosis? Histopathology 2016; 69: 492-498
19. Gaensler EA, Jederlinic PJ, Churg A: Idiopathic pulmonary fibrosis in asbestos-exposed workers. Am Rev Respir Dis 1991; 144: 689-696
20. Strongman H, Kausar I, Maher TM: Incidence, Prevalence, and Survival of Patients With Idiopathic Pulmonary Fibrosis in the UK. Adv Ther 2018; 35: 724-736
21. Arakawa H, Kishimoto T, Ashizawa K, et al: Asbestosis and other pulmonary fibrosis in asbestos-exposed workers: high-resolution CT features with pathological correlations. Eur Radiol 2016; 26: 1485-1492
22. Barbieri PG, Somigliana A, Festa R, Bercich L: Pulmonary concentration of asbestos fibers in steel workers with pleural mesothelioma. G Ital Med Lav Ergon. 2010; 32: 149-153
23. Akira M, Morinaga K: The comparison of high resolution computed tomography findings in asbestosis and idiopathic pulmonary fibrosis. Am J Ind Med 2016; 59: 301-306
24. Ranzieri S, Magrini EI, Mozzoni P, et al: Idiopathic Pulmonary Fibrosis and Occupational Risk Factors. Med Lav 2019; 110: 407-436