Which of the following statements are correct? a) Malignant mesothelioma is a radiologic finding that occurs mainly in workers involved in silicon processing. b) An image similar to sarcoidosis on chest X‑ray is seen in workers exposed to beryllium in the heavy‑metal industry. c) Coal‑workers’ pneumoconiosis initially presents with small rounded nodules in the upper lung fields on chest radiographs. d) Occupational asbestos exposure is a key risk factor for cancer of the nasal cavity and paranasal sinuses. e) Raynaud's phenomenon occurs primarily in individuals who work with wood.

Evaluation of Occupational Lung Disease Statements

Statement (b) is correct: beryllium exposure in heavy metals workers causes a sarcoid-like radiographic appearance. Statement (a) is incorrect because mesothelioma is associated with asbestos (not silicon) exposure. Statement (c) is incorrect because coal workers' pneumoconiosis initially presents in the upper lung fields but this is not the classical early pattern. Statement (d) is incorrect as asbestos is not a key risk factor for sinonasal cancers. Statement (e) is incorrect as Raynaud's phenomenon is not primarily associated with wood workers.

Statement-by-Statement Analysis

Statement A: Mesothelioma and Silicon Processing

This statement is incorrect. Malignant pleural mesothelioma is definitively linked to asbestos exposure, not silicon processing:

• Asbestos is the principal etiological agent of malignant pleural mesothelioma, with over 80% of cases in males attributable to occupational asbestos exposure 1
• The association between asbestos and mesothelioma was first established in the 1960s, with mesothelioma recognized as an occupational disease in the majority of cases 1
• Silica exposure causes silicosis, not mesothelioma, though silicosis is associated with increased lung cancer risk (2.4-fold increase in lung cancer mortality) 2, 3

Common pitfall: Confusing silica (silicon dioxide) exposure, which causes silicosis and increases lung cancer risk, with asbestos exposure, which causes mesothelioma.

Statement B: Beryllium and Sarcoid-Like Imaging

This statement is correct. Beryllium exposure in heavy metals industry workers produces radiographic findings similar to sarcoidosis:

• Chronic beryllium disease (berylliosis) presents with granulomatous inflammation that mimics sarcoidosis both clinically and radiographically
• Workers in the heavy metals industry, particularly those involved in aerospace, electronics, and nuclear industries, are at risk for beryllium exposure
• The radiographic pattern includes hilar lymphadenopathy and interstitial infiltrates similar to sarcoidosis

Statement C: Coal Workers' Pneumoconiosis Distribution

This statement is incorrect regarding the classical early presentation:

• Coal workers' pneumoconiosis pathologically begins with macules (present in 96% of cases) and progresses to micronodules (70%) and macronodules (45%) 4
• The radiographic profusion category 0/0 was often reported for cases with macules of mild to moderate grade and mild levels of micronodules, indicating chest X-rays are insensitive for detecting minimal CWP lesions 4
• While nodules do occur in upper lung fields, the statement oversimplifies the distribution pattern, as q-type opacities (associated with macules and micronodules) can have variable distribution 4

Important caveat: Chest radiographs show good overall agreement with pathologic CWP lesions (Somer's d = 0.64) but are unreliable in the presence of concomitant pulmonary pathology 4.

Statement D: Asbestos and Sinonasal Cancer

This statement is incorrect. Asbestos is not established as a key risk factor for nasal cavity and paranasal sinus cancers:

• A study of 50 patients with sinonasal malignancies found that a correlation between various types of sinonasal tumors and asbestos exposure could not be made 5
• While asbestos is a well-known carcinogen causing mesothelioma and bronchial cancer, the evidence does not support it as a key risk factor for sinonasal cancers 5
• The study did find an unexpected incidence of dusty workplaces (textile workers, wood-dust workers, cement workers) among sinonasal cancer patients, but not specifically asbestos 5

Key distinction: Asbestos primarily causes pleural mesothelioma and lung cancer, not sinonasal malignancies 1.

Statement E: Raynaud's Phenomenon and Wood Workers

This statement is incorrect. Raynaud's phenomenon is not primarily associated with wood workers:

• Raynaud's phenomenon in occupational settings is classically associated with vibration exposure (hand-arm vibration syndrome) from tools like jackhammers, chainsaws, and pneumatic drills
• While wood workers may use vibrating tools, the statement incorrectly implies a primary association with wood work itself rather than vibration exposure
• Occupational contributions to interstitial lung disease from wood dust exposure relate to hypersensitivity pneumonitis and potentially idiopathic pulmonary fibrosis, not Raynaud's phenomenon 6