Asbestos induced pericardial effusion and constrictive pericarditis

Our plain-English summary of Asbestos induced pericardial effusion and constrictive pericarditis, by D. Davies, M.I. Andrews, J.S. Jones (Thorax, 1991).

The study

• Authors: D. Davies, M.I. Andrews, J.S. Jones
• Journal: Thorax
• Published: 1991;46(6):429-32
• Type of article: Case report
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004970).

Abstract

The number of disorders attributable to asbestos exposure has increased gradually over the years. The latest to be recorded is pericardial effusion and constrictive pericarditis, and three cases are reported here. A man with bilateral pleural thickening and plaques developed acute pericarditis and an effusion and was treated by pericardiectomy. Two men died from constrictive pericarditis associated with bilateral pleural effusions and diffusion pleural thickening. The pericardium showed nonspecific fibrous thickening. All had been occupationally exposed to asbestos. In the fatal cases the lungs contained amphibole fibres, in keeping with a modest degree of occupational exposure. Asbestos produces progressive fibrosis of the pericardium that is similar to diffuse pleural thickening and may be fatal. Both conditions may develop after relatively short or light exposure.

In plain English

This article was a report of three cases of men occupationally exposed to asbestos who developed disease of the pericardium, the sac around the heart. The first man, aged 43, developed acute pericarditis with fluid around the heart in 1983. He also had diffuse thickening and calcified plaques of the pleura, the lining of the lungs. He had worked as a lagger for two years, with heavy exposure to asbestos of unknown type. Part of his pericardium was removed and he made a good recovery. The other two men died of constrictive pericarditis, in which a thickened, rigid pericardium restricts the heart, together with pleural effusions and diffuse pleural thickening. No tumour was found. Lung tissue from both contained crocidolite and amosite fibres, and in one also fibres the article prints as "chrysolite". The authors judged the men's exposure not heavy compared with lifelong insulation workers. They concluded that asbestos produces progressive fibrosis of the pericardium, similar to diffuse pleural thickening, which may be fatal and may follow relatively short or light exposure.

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 report (three cases)
• Who was studied: Three men occupationally exposed to asbestos, seen at hospitals in Nottingham and Portsmouth, England. Patient 1 was aged 43 in November 1983. Patient 2 was aged 64 in 1982 and died in January 1986. Patient 3 was aged 43 in July 1976 and died in 1980.
• Exposure: Occupational asbestos exposure. Patient 1: heavy exposure to asbestos of unknown type from age 18 to 20 as a lagger. Patient 2: Merchant Navy service, then marine engine fitter in a naval dockyard, with intermittent exposure over many years until 1982. Patient 3: in 1963 and 1964 worked alongside a man mixing an asbestos compound while casting lead grids, and in 1971 spent several months making car batteries, tipping bags of asbestos and mica into melted bitumen. The authors judged patient 3's heavy exposure to be almost certainly to crocidolite. Overall the authors considered the exposure not heavy compared with life long insulation workers.
• Main results:
  • Patient 1 developed acute pericarditis with a pericardial effusion, which appeared 23 years after his last asbestos exposure.
  • Patient 1 underwent partial pericardiectomy and made a good recovery, with no progression of his pleural thickening.
  • Patient 2 died. Necropsy showed a rigid, constrictive pericardium from dense hyaline thickening of both layers. No evidence of neoplasm was seen.
  • Patient 2's lung tissue contained 3.6 million crocidolite fibres and 22 million amosite fibres per gram of dry lung (printed by the scan as "3-6").
  • Patient 2 had a minor degree of asbestosis, which the authors judged did not contribute materially to his death from constrictive pericardial disease.
  • Patient 3 died from heart failure in 1980 at age 47. Necropsy showed severe pericardial restriction, with dense fibrous encapsulation of the heart up to 0.9 cm across. No neoplasm was present.
  • Patient 3's lung tissue showed no evidence of asbestosis.
  • Patient 3's lung tissue contained 2.5 million crocidolite fibres, 0.9 million amosite fibres and 14.2 million fibres printed as "chrysolite" per gram of dry lung.
• The authors' conclusion: The authors concluded that asbestos produces progressive fibrosis of the pericardium, similar to diffuse pleural thickening, that may be fatal, and that both conditions may develop after relatively short or light exposure. They presented the cases as showing that the pericardium responded in a way identical to the pleura.
• Limitations the authors state:
  • The authors stated that for patient 3 the time sequence was less clear, and it was unknown whether he ever had a pericardial effusion or whether the pericardial thickening developed on its own.
  • The type of asbestos patient 1 was exposed to was unknown.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Effusion, Asbestos Exposure, Bilateral, Pleural Thickening, Pericardiectomy, Pleural Effusion, Pericardium, Amphibole Group.

Related studies

• Constrictive pericarditis in a patient with fiberglass lung disease: a case report — C.Y. Hsu, H.Y. Chen, et al. (2024)
• Chronic constrictive pericarditis associated with asbestosis — L. Fischbein, M. Namade, et al. (1988)
• Pericardiectomy for treatment of neoplastic constrictive pericarditis — F. Buyukbayrak, E. Aksoy, et al. (2014)
• 18F-FDG PET/CT Revealing Constrictive Pericarditis as the Only Manifestation of Malignant Mesothelioma — J.P. Edel, H. Balink (2019)
• A case of pleural mesothelioma with effusive-constrictive pericarditis — N.A. Weir, B. Gerstenhaber (2001)
• Constrictive pericarditis after left extrapleural pneumonectomy and radiotherapy for malignant mesothelioma — E.J. Hickey, A.A. Khan, et al. (2007)

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