Asbestos-related lung disease: a pictorial review

Our plain-English summary of Asbestos-related lung disease: a pictorial review, by C. Norbet, A. Joseph, S.S. Rossi, et al (Current Problems in Diagnostic Radiology, 2015).

The study

• Authors: C. Norbet, A. Joseph, S.S. Rossi, S. Bhalla, F.R. Gutierrez
• Journal: Current Problems in Diagnostic Radiology
• Published: 2015;44(4):371-82
• Type of article: Review
• Cited by: 42 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos exposure can lead to a variety of adverse effects in the thorax. Although currently in the western world, levels of exposure are kept in check by strict regulations, history of previous asbestos exposure continues to have an effect on many, owing to the latent nature of the pathophysiological response of the body to the inhaled fibers. The adverse effects of asbestos generally fall under 3 categories: pleural disease, lung parenchymal disease, and neoplastic disease. Effects on the pleura include pleural effusions, plaques, and diffuse pleural thickening. In the parenchyma, rounded atelectasis, fibrotic bands, and asbestosis are observed. Differentiating asbestosis from other forms of interstitial lung diseases, such as idiopathic pulmonary fibrosis, usual interstitial pneumonia, smoking-related lung disease, and mixed interstitial lung diseases, is important because the prognosis, course of disease, and management of the patient should be tailored based on the specific etiology of the disease. In this review, imaging findings specific to asbestosis are discussed. Finally, exposure to asbestos can lead to neoplastic disease such as pleural mesothelioma, peritoneal mesothelioma, and bronchogenic carcinoma. The purpose of this article is to review the effects of asbestos exposure in the thorax, pathophysiology of these responses, and disease course. Particular emphasis is placed on the radiographic appearance of the disease, discussion of various imaging modalities and their utility, and the role of imaging in the management of patients with previous asbestos exposure and asbestos-related pulmonary disease.

Copyright © 2015 Mosby, Inc. All rights reserved.

In plain English

This article was a pictorial review, not a new study. It summarized published research and illustrated it with chest X-ray, CT, MRI and PET/CT images of patients, some described as having asbestos exposure. It covered pleural disease (effusions, pleural plaques, diffuse pleural thickening), lung disease (rounded atelectasis, fibrotic bands, asbestosis) and cancers (pleural, peritoneal and pericardial mesothelioma, and bronchogenic carcinoma). Its images showed individual cases, some with biopsy results, but it reported no new analysis of patient groups. It stated that there is no evidence that pleural plaques turn into mesothelioma. It said that only 20% of pleural mesothelioma cases occur in people without a known history of asbestos exposure, and that risk ratios of 1:100:500 for chrysotile, amosite and crocidolite have been postulated. It cited an earlier study by Leung and colleagues in which pleural rind on CT was 100% specific but 41% sensitive for malignant pleural disease. It also stated that non-asbestos-related peritoneal mesothelioma may make up as much as 50% of that disease. The authors concluded that radiologists have an integral role in diagnosing and managing these patients.

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: Pictorial (narrative) review of the literature on imaging of asbestos-related chest disease, illustrated with images of individual patients; no new analysis of patient groups
• Who was studied: No study population. The review drew on published literature and illustrated findings with images from individual patients, some with biopsy results. Some captions describe these patients as having asbestos exposure and others do not. The number of patients and their source are not stated.
• Exposure: Asbestos in general. The review described amphiboles (crocidolite, amosite, tremolite, anthophyllite) and the serpentine chrysotile. It listed exposure through asbestos mining and processing and through secondary occupations such as insulation and textile manufacturing, construction, shipbuilding, and the manufacture and repair of gaskets and brake linings.
• Main results:
  • Pleural plaques (review statement citing earlier literature): there is no evidence that pleural plaques undergo malignant degeneration into mesothelioma.
  • Diffuse pleural disease on CT (from an earlier study by Leung et al, not this article): pleural rind was 100% specific and 41% sensitive for malignant pleural disease as opposed to benign pleural thickening.
  • Malignant pleural mesothelioma (review statement citing earlier literature): only 20% of cases occur in patients without a known history of asbestos exposure.
  • Fiber type and mesothelioma (review statement citing earlier literature): risk ratios for chrysotile, amosite and crocidolite of 1:100:500, respectively, have been postulated.
  • Peritoneal mesothelioma (review statement citing earlier literature): non-asbestos-related malignant peritoneal mesothelioma may be as much as 50% of cases.
  • Lung cancer (review statement citing earlier literature): amphiboles are 10-50 times more potent than chrysotile in inducing lung cancer.
• The authors' conclusion: The authors concluded that radiologists have an integral role in the diagnosis and management of patients with asbestos-related lung disease. They stated that recognizing the imaging appearance of these diseases is crucial to getting patients proper treatment.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Thorax, Pleura, Pleural Effusion, Diffuse Pleural Thickening, Parenchyma, Rounded Atelectasis, Interstitial Lung Disease.

Related studies

• Primary sarcomatoid malignant pericardial mesothelioma — D. Jiang, M. Kong, et al. (2013)
• Primary pericardial tumors — C.S. Restrepo, D. Vargas, et al. (2013)
• Imaging of the pleura — E.J. Helm, T.N. Matin, et al. (2010)
• Imaging in pleural mesothelioma: A review of the 14th International Conference of the International Mesothelioma Interest Group — S.G. Armato, R.J. Francis, et al. (2019)
• From the archives of the AFIP: primary peritoneal tumors: imaging features with pathologic correlation — A.D. Levy, J. Arnáiz, et al. (2008)
• What is the best way to diagnose and stage malignant pleural mesothelioma? — I. Zahid, S. Sharif, et al. (2011)

Browse return to medical research.