Asbestos: when the dust settles an imaging review of asbestos-related disease

Our plain-English summary of Asbestos: when the dust settles an imaging review of asbestos-related disease, by H.D. Roach, G.J. Davies, R. Attanoos, et al (Radiographics, 2002).

The study

• Authors: H.D. Roach, G.J. Davies, R. Attanoos, M. Crane, H. Adams, S. Phillips
• Journal: Radiographics
• Published: 2002;22 Spec No:S167-84
• Type of article: Review
• Cited by: 80 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos-related neoplastic and nonneoplastic diseases of the lungs and pleura range from pleural effusion and pleural plaques to lung cancer and malignant mesothelioma. Pleural effusions are typically hemorrhagic exudates of mixed cellularity but do not typically contain asbestos bodies. The classic distribution of pleural plaques seen on chest radiographs is the posterolateral chest wall between the seventh and tenth ribs, lateral chest wall between the sixth and ninth ribs, the dome of the diaphragm, and the mediastinal pleura. Computed tomographic (CT) findings support this distribution but also show anterior and paravertebral plaques not well shown at chest radiography. Imaging features of diffuse pleural thickening include a continuous sheet, often involving the costophrenic angles and apices, that rarely calcifies. The typical CT features of round atelectasis are of a round or oval mass that abuts the pleura, a "comet tail" of bronchovascular structures going into the mass, and thickening of the adjacent pleura. Features of asbestosis on chest radiographs include ground-glass opacification, small nodular opacities, "shaggy" cardiac silhouette, and ill-defined diaphragmatic contours. CT, however, is more sensitive in their detection. Chest radiography in patients with malignant mesothelioma may show an effusion, pleural thickening, and as the tumor progresses, a more lobulated outline. CT can help identify the disease in its early stages. Asbestos-related cancers can occur anywhere in the lungs. Recognition of the clinical, radiologic, and pathologic features of these diseases will be important for some years to come.

In plain English

This article was a review, not an original study. The authors described how asbestos-related diseases of the chest look on imaging, with emphasis on how imaging matches pathology. They illustrated it with radiographs, CT scans and tissue photographs, some from patients described as asbestos-exposed. The review described pleural plaques as the most common sign of asbestos exposure, typically sparing the lung apices and costophrenic angles. It described diffuse pleural thickening as a continuous sheet, often involving the costophrenic angles. Round atelectasis appeared on CT as a round or oval mass touching the pleura, with lung cancer the main alternative diagnosis. The review stated that CT, especially high-resolution CT, is more sensitive than plain radiographs for asbestosis. It described malignant mesothelioma as strongly associated with asbestos exposure, particularly crocidolite. In mesothelioma, chest radiographs usually showed an effusion, and CT most commonly showed pleural thickening. For lung cancer, it stated that smoking has a more than additive effect. The authors concluded that these diseases will persist for some time.

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: Narrative imaging review (education exhibit) with histopathologic correlation; not original research
• Who was studied: No defined study population. The review is illustrated with images and specimens from individual patients, number not stated. Only some are described as asbestos-exposed.
• Exposure: Asbestos in general. The review describes the fiber types chrysotile, crocidolite, amosite, anthophyllite, tremolite and actinolite.
• Main results:
  • The review describes pleural plaques as the most common manifestation of asbestos exposure
  • The review states that pleural plaques typically spare the lung apices and costophrenic angles
  • The review describes diffuse pleural thickening on imaging as a continuous sheet, often involving the costophrenic angles
  • The review describes round atelectasis on CT as a round or oval mass abutting the pleura
  • The review names lung cancer as the main differential diagnosis for round atelectasis
  • The review states that CT, especially high-resolution CT, is more sensitive than plain radiography for asbestosis
  • The review describes malignant mesothelioma as strongly associated with asbestos exposure, particularly crocidolite
  • The review states that in malignant mesothelioma, chest radiography usually shows an effusion
  • The review states that in malignant mesothelioma, pleural thickening is the most common CT finding
  • For asbestos-related lung cancer, the review states that smoking has a more than additive effect
• The authors' conclusion: The authors concluded that asbestos-related diseases, especially asbestosis and malignant mesothelioma, will persist for some time, so it will be some time before the dust has settled

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: Pleura, Pleural Effusion, Pleural Plaques, Lung Cancer, Malignant Mesothelioma, Exudate, Asbestos Bodies, Chest X-Ray.

Related studies

• Asbestos-related pleural disease: value of dedicated magnetic resonance imaging techniques — M.A. Weber, M. Bock, et al. (2004)
• Imaging of the pleura — N.L. Müller (1993)
• Environmental asbestos-related pleural plaque in southeast of Turkey — G. Ates, T. Yildiz, et al. (2010)
• Asbestos-related chest diseases: plain radiographic findings — W.T. Miller, W.B. Gefter, et al. (1992)
• Non-malignant asbestos-related diseases: a clinical view — D. Fishwick, C.M. Barber (2014)
• Asbestos-related diseases of lung and pleura: clinical picture and illustrative cases — B. Varkey, U.N. Kumar (1978)

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