Asbestos-related rounded atelectasis. Radiologic and mineralogic data in 23 cases

Our plain-English summary of Asbestos-related rounded atelectasis. Radiologic and mineralogic data in 23 cases, by C. Voisin, F. Fisekci, S. Voisin-Saltiel, et al (Chest, 1995).

The study

• Authors: C. Voisin, F. Fisekci, S. Voisin-Saltiel, J. Ameille, P. Brochard, J.C. Pairon
• Journal: Chest
• Published: 1995;107(2):477-81
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A retrospective study was conducted in 23 subjects with previous occupational exposure to asbestos and exhibiting rounded atelectasis (RA) on high-resolution computed tomography scan (HRCT scan) to evaluate the retention of asbestos bodies (ABs) using light microscopy in the bronchoalveolar lavage (BAL) fluid or lung parenchyma in such patients. A total of 31 RAs were identified, usually located in the lower (25 RAs) and posterior (23 RAs) parts of the lung. Pleural thickening in contact with the RA was observed in 27 RAs and parenchymal bands were detected in 15 cases. Twelve of the 20 patients who underwent BAL or surgery exhibited significant retention of ABs in BAL fluid or lung tissue. Moreover, a significant retention of ABs was observed in five of nine patients with a history of asbestos exposure but no diffuse pleural thickening on chest radiograph or interstitial opacities on HRCT scan. Patients with RAs and coexisting diffuse pleural thickening and/or interstitial fibrosis should be considered at a higher risk for lung cancer in comparison to patients with isolated circumscribed pleural plaques based on increased AB counts. By contrast, the excess risk of lung cancer is more questionable in patients with only RAs and circumscribed pleural plaques as they may have AB counts either above or below that associated with pleural plaques alone. This emphasizes the need for further follow-up studies to define criteria indicating the need for thoracotomy in these subjects.

In plain English

This retrospective study reviewed 23 consecutive men (mean age 62) diagnosed by high-resolution CT (HRCT) with rounded atelectasis, a benign mass of folded lung, at a lung department in Creteil, France, between 1989 and 1993. A questionnaire rated their occupational asbestos exposure as definite in 15, probable in 3, possible in 4 and absent in 1. HRCT showed 31 rounded atelectases, mostly in the lower (25) and back (23) lung. Standard chest X-rays suggested rounded atelectasis in only 2 patients. Asbestos bodies were counted by light microscopy in lung-washing (BAL) fluid or lung tissue for 20 patients. Twelve of these 20 exceeded the laboratory thresholds for significant retention. There were nine patients with a history of asbestos exposure but no diffuse pleural thickening on chest X-ray or interstitial opacities on HRCT. Five of them had significant retention. Among 21 patients followed with imaging, masses mostly stayed stable. Two showed a slight increase and one a new atelectasis. Surgery in seven patients excluded cancer. The authors considered excess lung cancer risk more questionable in patients with only rounded atelectasis and circumscribed pleural plaques.

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 case series (review of 23 consecutive cases)
• Who was studied: 23 men, mean age 62, with a radiologic diagnosis of rounded atelectasis between 1989 and 1993 at the Lung Department of the Intercommunal Hospital Center of Creteil, France. They were referred from hospitals in the Paris area (Creteil 14, Corbeil 5, Hotel Dieu 4). Four were current smokers, 2 nonsmokers and 17 former smokers.
• Exposure: Occupational asbestos exposure was assessed by a standardized questionnaire and job review: definite in 15, probable in 3, possible in 4, none in 1. Mean latency from first exposure was 37.5 years and mean duration of exposure 21.9 years. Fiber types were not specified. Asbestos bodies were counted by light microscopy. Significant retention was defined as above 1 asbestos body per milliliter of BAL fluid or above 1,000 per gram of dry lung tissue.
• Main results:
  • 31 rounded atelectases were identified on HRCT in the 23 patients: 16 patients had 1, 6 had 2, and 1 had 3.
  • The atelectases were usually in the lower (25) and posterior (23) parts of the lung.
  • On standard chest radiographs, an opacity suggestive of rounded atelectasis was seen in only 2 patients. Pleural plaques were seen in 19 patients and diffuse pleural thickening in 10.
  • On HRCT, interstitial opacities suggesting asbestosis were seen in five patients and parenchymal bands in 15 patients.
  • Asbestos body counts were above threshold in BAL fluid for 12 of 18 patients and in lung tissue for 4 of 6 patients. Overall, significant retention was found in 12 of the 20 patients analyzed.
  • Nine of the 12 patients with significant retention had definite exposure on the questionnaire.
  • Nine patients had a history of asbestos exposure but no diffuse pleural thickening on chest radiograph and no interstitial opacities on HRCT. Five of these nine had significant asbestos body retention.
  • Impaired CO transfer was found in 6 of the 16 patients tested.
  • Twenty-one of the 23 patients were followed with radiographs or HRCT. The mass increased slightly in two, a new atelectasis appeared in one, and the rest showed no change. Thoracotomy in seven patients excluded malignancy.
• The authors' conclusion: The authors concluded that patients with rounded atelectasis plus diffuse pleural thickening and/or interstitial fibrosis should be considered at higher lung cancer risk than patients with isolated circumscribed pleural plaques. For patients with only rounded atelectasis and circumscribed plaques, they considered the excess lung cancer risk more questionable, because asbestos body counts may be above or below those seen with plaques alone. They called for follow-up studies to define when thoracotomy is needed.
• Limitations the authors state:
  • The authors could not draw conclusions about how rounded atelectasis develops. They had no information on the patients before inclusion, and benign pleural effusion can be symptomless.
  • The authors stated that follow-up over a longer period is needed to assess the prognostic value of these masses.

Topics

Medical terms in this study, explained in our Lexicon: Rounded Atelectasis, Occupational Exposure, High-Resolution CT (HRCT), Asbestos Bodies, Bronchoalveolar Lavage (BAL), Parenchyma, Pleural Thickening, BAL Fluid.

Related studies

• Rounded atelectasis. Clinical experience with 74 patients — G. Hillerdal (1989)
• Rounded atelectasis of the lung — G.T. Stathopoulos, M.T. Karamessini, et al. (2005)
• Rounded atelectasis associated with pulmonary lymphangioleiomyomatosis — K. Kishi, S. Homma, et al. (2005)
• Rounded atelectasis due to acute exudative effusion. Spontaneous resolution — L.S. Smith, R.F. Schillaci (1984)
• Rounded atelectasis and mesothelioma — R.F. Munden, H.I. Libshitz (1998)
• An unusual case of rounded atelectasis — G. Geremia, R.A. Mintzer (1984)

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