Biomass Fuel Exposure and Lungs: Unraveling the Imaging Conundrum

Prolonged exposure to biomass fuel smoke is a proven irritant, known to aggravate chronic lung diseases. Of the myriad spectrum of thoracic manifestations associated with inhalation of biomass fuel smoke, bronchial anthracofibrosis is a recently described entity characterized by bronchial narrowing and visible anthracotic pigmentation on bronchoscopy. Common imaging features include bronchostenosis, peribronchial soft tissue with or without calcification along with peribronchial lymph nodes. Its close similarity to endobronchial tuberculosis and bronchogenic carcinoma in clinical presentation and imaging poses a diagnostic challenge and hence underlines the importance of knowledge about this entity. This review aims to summarize the key imaging features of bronchial anthracofibrosis while also briefly discussing the spectrum of thoracic manifestations including distinct entities associated with biomass fuel smoke exposure.