Acute pleurisy in asbestos exposed persons

Our plain-English summary of Acute pleurisy in asbestos exposed persons, by G.K. Sluis-Cremer, I. Webster (Environmental Research, 1972).

The study

• Authors: G.K. Sluis-Cremer, I. Webster
• Journal: Environmental Research
• Published: 1972;5(4):380-92
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001350).

Abstract

It has been clinically observed that pleural effusion occurs, not infrequently, in asbestos exposed persons with or without evidence of asbestosis. Nine such cases are presented, in seven of these, pleural biopsy has been carried out by needle or by open thoracotomy. The histological features are described. The suspicion of mesothelioma of the pleura necessarily arises in such cases. This problem is discussed.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This article was a series of case reports from South Africa's National Research Institute for Occupational Diseases. It described nine asbestos-exposed workers who developed pleural effusion, which is fluid around the lung. They had worked at amosite, blue asbestos, chrysotile or other asbestos mines or mills. Seven had a pleural biopsy, either by needle or by open chest surgery. In cases 1 to 3 the biopsies showed dense hyaline connective tissue with clefts and no tuberculous granuloma, which the authors called a fairly characteristic picture. Cases 2 and 4 to 8 had X-ray or tissue evidence of asbestosis. Cultures for tuberculosis were negative where reported, but the authors said doubt about the cause remained in some cases. In case 4 the biopsy suggested the tissue could have come from a pleural mesothelioma. However, the effusion went away on its own and the patient was well after one year, and the authors said long-term follow-up was needed. The authors concluded that pleural mesothelioma must be borne in mind in all such effusions. These reports describe individual patients, not how often this happens.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series (nine case reports), with biopsy findings described
• Who was studied: Nine asbestos-exposed persons with pleural effusion in South Africa, described as Caucasian or Bantu, with illnesses between the 1950s and 1970; seven had pleural biopsy by needle or open thoracotomy
• Exposure: Work at asbestos mines and mills. Cases 1, 2 and 9 worked at amosite mines. Cases 3, 6 and 7 worked at blue asbestos mines or mills. Case 4 worked at asbestos mines in the North West Cape for 16 years. Case 5 worked at a Northern Transvaal asbestos mine. Case 8 had 15 years on chrysotile mines and also worked in gold and copper mines. Jobs included miner, carpenter, mill fitter, labourer, and mill, store and office work. No dust measurements were given.
• Main results:
  • In cases 1 to 3 the pleural biopsies showed hyaline connective tissue with clefts lined by flattened cells and no tuberculous granuloma or cell infiltration. The authors called this a fairly characteristic picture.
  • Cases 2 and 4 to 8 had radiological or histological evidence of asbestosis.
  • Where reported, cultures of pleural fluid or sputum for tuberculosis were negative (for example in case 7).
  • In case 4 the biopsy from the visceral pleura was thought to possibly come from a pleural mesothelioma. A reactive pleurisy could not be fully excluded. The effusion subsided on its own and the patient remained well after 1 year of follow-up.
  • In case 8 the biopsy showed no evidence of malignant neoplasia and the left-side effusion subsided spontaneously. In the discussion, however, the authors described the appearances in case 8 as very suspicious of a mesothelioma, while noting the patient remained clinically well nearly 2 years after biopsy.
  • In case 2 an E.S.R. of 53 with a hemoglobin of 11.1 raised the possibility of another cause. Even so, the authors judged that the extensive pleural calcification and the biopsy findings strongly suggested asbestosis as the cause.
  • In case 7 the effusions receded without anti-tuberculous treatment, and changes consistent with asbestosis appeared. The authors said some doubt remained because two of his cousins had tuberculosis.
• The authors' conclusion: The authors concluded that pleural mesothelioma must be kept in mind in all such pleural effusions, especially because a needle biopsy may miss malignant tissue.
• Limitations the authors state:
  • The authors stated that the cause of a pleural effusion is always difficult to determine, and that suspicion of tuberculosis lingers despite negative tests.
  • The authors stated that long-term follow-up was required in case 4 to finally exclude mesothelioma.
  • The authors noted that a needle biopsy may miss malignant tissue.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Pleurisy, Pleural Effusion, Pleural Biopsy, Thoracotomy, Mesothelioma, Pleura.

Related studies

• Rarity of mineral fibre pleurisy among persons exposed to Finnish anthophyllite and with low risk of mesothelioma — G. Hillerdal, A. Zitting, et al. (1984)
• Ventilatory failure due to asbestos pleurisy — A. Miller, A.S. Teirstein, et al. (1983)
• Pathogenesis of pleurisy, pleural fibrosis, and mesothelial proliferation — A. Herbert (1986)
• Benign asbestos pleurisy in the rabbit. A model for the study of pathogenesis — B.L. Shore, C.C. Daughaday, et al. (1983)
• Cause of Asbestos-Induced Pleurisy Forgotten — E. Böhm (2019)
• An outbreak of pleural mesothelioma and chronic fibrosing pleurisy in the village of Karain/Urgüp in Anatolia — Y.I. Baris, A.A. Sahin, et al. (1978)

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