Asbestos pleural effusion

Our plain-English summary of Asbestos pleural effusion, by E.A. Gaensler, A.I. Kaplan (Annals of Internal Medicine, 1971).

The study

• Authors: E.A. Gaensler, A.I. Kaplan
• Journal: Annals of Internal Medicine
• Published: 1971;74(2):178-91
• Cited by: 96 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. 001359).

In plain English

This was a case series from the authors' laboratories at Boston University. A computer search of records for 4,077 patients seen between 1951 and 1969 found 57 with asbestosis or asbestos exposure. Of these, 24 also had pleural effusion (fluid around the lungs). After 12 whose effusions occurred with mesothelioma, bronchogenic carcinoma or congestive heart failure were excluded, 12 men (21.1% of those with asbestosis or asbestos exposure) were judged to have "asbestos pleural effusion". Their asbestos exposure had lasted 3 to 38 years, and three also had talc exposure. Effusions were often recurrent and usually bilateral. Cultures of the fluid grew nothing, and no tumor cells were found. Lung tissue examined showed chronic interstitial pneumonitis and asbestos bodies in every case. One man developed a malignant pleural mesothelioma probably 12 and certainly 9 years after his first effusion. The authors concluded that asbestos pleural effusion may not be uncommon. They noted that their own data cannot show how important it is, and that exposure dose could not be established.

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 (12 patients) identified by a computer search of laboratory records, with clinical follow-up, lung function tests, and surgical or autopsy pathology
• Who was studied: 12 men aged 33 to 60, followed for 1 to 9 years. They were selected from 4,077 patients seen in Boston University thoracic laboratories between 1951 and 1969. Of the 57 patients with asbestosis or asbestos exposure, 24 also had pleural effusion; 12 of these were excluded because the effusion was related to mesothelioma, bronchogenic carcinoma or congestive heart failure. Patients from the Sanatorium Division and people seen only in surveys were also excluded.
• Exposure: Occupational asbestos exposure lasting 3 to 38 years, often identified only after detailed questioning. Jobs included tile manufacture, steam and pipe fitting, boiler and pipe insulation, bricklaying beneath workers spraying asbestos fireproofing, auto undercoating, and work in asbestos products plants. Specific fiber types were not named.
• Main results:
  • The 12 men with asbestos pleural effusion made up 21.1% of all patients in the series with asbestosis or asbestos exposure.
  • Effusions were often recurrent and usually bilateral, and were frequently followed by continuing chest pain. Effusions were on one side only in three of the 12 patients.
  • Six patients had a single episode of effusion and five had two to four episodes. In Case 10 the bilateral effusions never disappeared.
  • Cultures of the pleural fluid never grew bacteria, fungi or tuberculosis organisms.
  • No tumor cells were found in the pleural fluid.
  • In the patients with pathology material, chronic interstitial pneumonitis of varying severity was found in all cases examined.
  • Asbestos (ferruginous) bodies were found in all lungs examined.
  • In the pleura, asbestos bodies or fibers were absent in two cases.
  • Of the 11 patients who had lung function tests, only three had significant restriction (reduced vital capacity).
  • Six patients had severely reduced diffusing capacity.
  • By the authors' clinical criteria, six of the 12 patients had asbestosis.
  • Overall, some degree of parenchymal asbestosis was present in 10 of the 12 cases.
  • Three patients (Cases 1, 3 and 12) also had talc exposure.
  • One patient (Case 2, a steamfitter and gas fitter) was found to have a malignant pleural mesothelioma probably 12 and certainly 9 years after his first effusion. The authors said this may have been coincidence, a precursor relationship, or a very slowly growing tumor.
• The authors' conclusion: The authors concluded that asbestos pleural effusion may not be an uncommon manifestation of asbestos exposure. In their view, the diagnosis rests on an otherwise unexplained effusion together with a history of asbestos exposure, which may have been brief or intermittent.
• Limitations the authors state:
  • The authors stated that their data are not representative, because their laboratories mainly receive symptomatic outpatient referrals.
  • The authors could not establish a dose-time relationship, because the work was largely unsupervised and exposure was often unsuspected. They therefore said the exposure durations reported have little meaning.
  • The authors cautioned that the mere coexistence of effusion and asbestos exposure could be overinterpreted.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleural Effusion.

Related studies

• Pleural effusion during bromocriptine exposure in two patients with pre-existing asbestos pleural plaques: a relationship? — C. Knoop, M. Mairesse, et al. (1997)
• Evolution of idiopathic pleural effusion: a prospective, long-term follow-up study — J.S. Ferrer, X.G. Muñoz, et al. (1996)
• Benign asbestos pleural effusion associated with pulmonary aspergilloma — J. Hiyama, M. Marukawa, et al. (1998)
• Diffuse pleural thickening following heart failure-related pleural effusions in an asbestos exposed patient — M. Evison, P. Barber (2015)
• Chronic empyema: importance of preventing complications in the management of pleural effusions — V. Molander, M. Diakopoulou, et al. (2013)
• Asbestos pleural effusion: a clinical entity — G. Mårtensson, S. Hagberg, et al. (1987)

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