Asbestos exposure and tuberculous pleurisy as developmental causes of progressive unilateral upper-lung field pulmonary fibrosis radiologically consistent with pleuroparenchymal fibroelastosis

Our plain-English summary of Asbestos exposure and tuberculous pleurisy as developmental causes of progressive unilateral upper-lung field pulmonary fibrosis radiologically consistent with pleuroparenchymal fibroelastosis, by A. Sekine, E. Hagiwara, T. Iwasawa, et al (Respiratory Investigation, 2021).

The study

• Authors: A. Sekine, E. Hagiwara, T. Iwasawa, R. Otoshi, T. Erina, R. Shintani, H. Okabayashi, S. Ikeda, T. Oda, R. Okuda, H. Kitamura, T. Baba, S. Komatsu, T. Ogura
• Journal: Respiratory Investigation
• Published: 2021;59(6):837-844
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Unilateral upper-lung field pulmonary fibrosis (upper-PF), which is radiologically consistent with pleuroparenchymal fibroelastosis, develops after thoracic surgery. In most patients with unilateral upper-PF, aberrant intra-/extra thoracic air commonly emerges and an autopsy shows chronic pleuritis, which indicates that pleural involvement is associated with upper-PF development. If so, there may be patients with unilateral upper-PF who have a history of pleural involvement, including tuberculous pleurisy (TP) or asbestos exposure (AE). This study aimed to examine this supposition.

Methods: We examined the radiological reports of all consecutive patients from 2012 to 2018 to investigate whether there were patients having unilateral upper-PF and a history of TP or AE.

Results: Eight patients were included in the study. Five patients had a history of TP, and the remaining three had that of AE. All patients were men and had respiratory symptoms, and seven patients presented with restrictive ventilatory impairment. The interval between TP or last AE and upper-PF development was long, with a median of over 20 years. The upper-PF lesion was commonly located in the right lung, and aberrant intrathoracic air was observed in five patients during their clinical course. Additionally, the upper-PF lesion transformed into a cystic lesion in six patients, which resulted in Aspergillus infection in two patients. The prognosis was poor, with a median overall survival of 38 months.

Conclusions: Unilateral upper-PF developed even in patients with a history of pleural involvement. Our results indicate that pleural involvement plays an important role in the development of unilateral upper-PF.

Copyright © 2021 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

In plain English

This retrospective study at one hospital in Yokohama, Japan, looked for patients with scarring in the upper part of one lung resembling a rare condition called pleuroparenchymal fibroelastosis (PPFE), who also had a past history of tuberculous pleurisy or asbestos exposure. Of 20,579 patients given chest CT scans between March 2012 and April 2018, 42 had this one-sided upper-lung fibrosis. After exclusions, eight men were included. Five had a history of tuberculous pleurisy and three had a history of occupational asbestos exposure, in work listed as asbestos insulation, an oil refinery plant and a thermal power plant. The article did not name fiber types. In the three asbestos-exposed men, the fibrosis developed 19 to 39 years after the last exposure, and all three had pleural plaques on the left side. Across all eight, abnormal air around the lung was seen in five, and the lung lesion worsened afterward in all five. Four patients died of respiratory disease. Median overall survival was 38.0 months. The authors concluded that pleural involvement may play a major role in this disease. They noted that the study was small and that asbestos exposure was based on patients' histories.

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: Retrospective single-institution case series based on a search of chest CT radiology reports
• Who was studied: Eight men (median age 76) with progressive unilateral upper-lung field pulmonary fibrosis, selected from 20,579 consecutive patients evaluated with chest CT at the Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan, from March 2012 to April 2018. Of these patients, 42 had progressive unilateral upper-PF; 27 were excluded for prior thoracic surgery, radiotherapy or mycobacterial lung infection, and 7 for having no definite cause.
• Exposure: Five patients had a history of tuberculous pleurisy and three had a history of occupational asbestos exposure (asbestos insulation, oil refinery plant work, thermal power plant work). Asbestos exposure lasted 10 to 39 years. Fiber types were not named.
• Main results:
  • In the three patients with occupational asbestos exposure, upper-PF developed 19 to 39 years after the last asbestos exposure
  • All three asbestos-exposed patients had pleural plaque on the left side at the time of upper-PF diagnosis
  • In the five patients with tuberculous pleurisy, the interval from tuberculous pleurisy to upper-PF ranged from 7 to 68 years, with a median of 20 years
  • The upper-PF lesion was on the right side in six of the eight patients
  • Aberrant air (suggestive of pleural fistula) was seen in five of the eight patients (62.5%), repeatedly in three. The lesion worsened after the first aberrant air in all five.
  • The lesions turned into cystic lesions in six of the eight patients, two of whom developed pulmonary aspergillosis
  • The median percentage of predicted forced vital capacity among the patients was 71.4%
  • By the end of follow-up, four of the eight patients had died of respiratory disease
  • Median overall survival after diagnosis of unilateral upper-PF was 38.0 months
• The authors' conclusion: The authors concluded that unilateral upper-PF developed in patients with a history of pleural involvement, including tuberculous pleurisy or occupational asbestos exposure, and that these results may indicate pleural involvement plays a major role in its development.
• Limitations the authors state:
  • Small retrospective study at a single institution; more cases are needed to confirm the results
  • Asbestos exposure history was based on history taking, so unilateral upper-PF could be an extreme, uneven form of idiopathic PPFE
  • Tuberculous pleurisy was not treated at the institution, and complication by pulmonary tuberculosis could not be completely ruled out
  • The lung lesions were not examined pathologically (no biopsy), owing to poor lung function and advanced age

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Tuberculous pleurisy, Pulmonary Fibrosis, Thoracic Surgery, Autopsy, Intrathoracic, Prognosis, Median Overall Survival.

Related studies

• Asymmetric rapidly progressive lung fibrosis: a cause of pseudotumour in asbestosis — W.O. Cookson, J.J. Glancy, et al. (1985)
• Idiopathic pleuroparenchymal fibroelastosis: an unrecognized or misdiagnosed entity? — C.D. Becker, J. Gil, et al. (2008)
• A CARE-compliant case report: Lung transplantation for a Chinese young man with idiopathic pleuroparenchymal fibroelastosis — H. Huang, R. Feng, et al. (2017)
• Pathogenesis of pleurisy, pleural fibrosis, and mesothelial proliferation — A. Herbert (1986)
• Exploring efficacy and safety of oral Pirfenidone for progressive, non-IPF lung fibrosis (RELIEF) - a randomized, double-blind, placebo-controlled, parallel group, multi-center, phase II trial — J. Behr, P. Neuser, et al. (2017)
• Massive bilateral upper lobe fibrosis secondary to asbestos exposure — R.A. Green, D.G. Dimcheff (1974)

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