“Ladakh lung” a non-occupational pneumoconiosis; spectrum of high resolution computed tomography findings

Background: Ladakh is one of the world's highest inhabited regions and has a unique environmental features due to presence of both free silica and biomass fuel which is responsible for lung disease. Cases of non-occupational pneumoconiosis has been reported from Ladakh. Objectives: To establish the spectrum of High Resolution CT findings in Symptomatic patients with Non-Occupational Pneumoconiosis from Ladakh region of J&K. Methods: This is an observational study that was carried out over a period of 18 months in the Department of Radio diagnosis, Department of Pulmonary Medicine and Department of Medicine of Govt. Medical College Srinagar after approval from Institutional Ethical Committee. Results: The most common finding among study patients was nodules in 88% of patients, mediastinal lymphadenopathy in 72% followed by bronchial thickening in 60% , linear fibrotic bands in 58%, Calcified mediastinal lymphadenopathy in 54%, ground glass opacity in 48% , multifocal bronchial narrowing in 40%, emphysema in 40%, bronchiectasis in 36%, lung cavitation in 32%, segmental/lobar collapse in 32%, reticulation in 30%, mosaic attenuation 26%, consolidation in 20%, progressive massive fibrosis in 20%, pleural thickening in 20%, honeycombing in 12%,pleural calcification in 4% of patients. Conclusion: To conclude clinicians and radiologists have less awareness of non-occupational pneumoconiosis and thus the diagnosis of non-occupational pneumoconiosis is rarely suggested on imaging and instead common diagnosis like tuberculosis are suggested, So our study may help in clinching diagnosis. Advances in Knowledge: Only few case reports and case series on patients from Ladakh region with non occupational pneumoconiosis has been reported. This is the first study describing HRCT features. Since tuberculosis is endemic in India, occupational pneumoconiosis was being confused and treated as pulmonary tuberculosis. Our study suggests that certain radiological features can differentiate between tuberculosis from non occupational pneumoconiosis.