Benign asbestos pleural effusion: diagnosis and course

Our plain-English summary of Benign asbestos pleural effusion: diagnosis and course, by B.W. Robinson, A.W. Musk (Thorax, 1981).

The study

• Authors: B.W. Robinson, A.W. Musk
• Journal: Thorax
• Published: 1981;36(12):896-900
• Cited by: 47 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. 000772).

Abstract

We have reviewed 22 patients with benign asbestos pleural effusion seen over a 17-year period. The mean duration of exposure to asbestos was 5.5 years and the mean interval between exposure and presentation was 16.3 years. In five the effusion was asymptomatic. Fever was uncommon but in 15 of 21 patients the ESR was elevated. Leucocytosis was noted in seven of 20 patients. Autoantibodies were rarely detected. The pleural fluid was usually blood-stained and the volume aspirated was rarely larger than 500 ml. Pleural biopsies revealed established pleural fibrosis and/or inflammatory infiltration with fibrinous exudate and mesothelial and fibroblastic proliferation. A positive mantoux test was noted in eight of 12 patients but there was no other evidence of tuberculosis. The mean duration to spontaneous resolution of the effusion was 4.3 months. During a follow-up period of 28.1 years from initial exposure to asbestos (mean 22.8 years) and up to 17.2 years from initial presentation with a pleural effusion (mean 6.3 years) seven patients had a single recurrence and only one patient had multiple pleural effusions. Only three patients experienced persistent pleural pain. It was not possible to predict the likelihood of recurrence of an effusion or the persistence of pleural pain from the data at presentation. No patient subsequently developed mesothelioma or other neoplasm.

In plain English

The authors reviewed 22 men seen over 17 years at a Western Australian respiratory department, all meeting accepted criteria for benign asbestos pleural effusion: asbestos exposure, fluid around the lung with no other cause found, and resolution on its own or no recurrence after drainage. Fifteen had mined or milled crocidolite (blue asbestos) at Wittenoom Gorge; exposure was mainly to crocidolite. Fourteen men came with pleuritic chest pain; five had no symptoms. An inflammation blood test (ESR) was raised in 15 of 21 patients, and the fluid was frankly blood-stained in 13 men. Eight of 12 tested had a positive Mantoux test, but no other evidence of tuberculosis was found. In 16 patients the effusion cleared in a mean of 4.3 months. Eight patients had more than one effusion and three had lasting chest pain. No patient developed pleural or peritoneal mesothelioma or other cancer during follow-up. The authors concluded that further effusions and persistent pain were uncommon and malignant change not yet documented. They noted some patients had not yet reached the 20 to 40 years after exposure when mesothelioma peaks.

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 of patients who met three stated diagnostic criteria: previous asbestos exposure, pleural effusion with no demonstrable alternative cause, and spontaneous resolution or non-recurrence after aspiration. Data came from hospital case records and from telephoning patients and their general practitioners.
• Who was studied: 22 men with benign asbestos pleural effusion seen over a 17-year period at the Department of Respiratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia. Two died of unrelated causes soon after diagnosis; 19 were reported as followed up.
• Exposure: Mainly crocidolite. 15 men mined and/or milled crocidolite at Wittenoom Gorge; 4 cut asbestos sheeting; 1 was exposed to asbestos spray while insulating railway coaches; 1 plumber was exposed to asbestos pipe lagging; 1 cleaned bags that had held asbestos from Wittenoom Gorge and South Africa. Mean exposure duration was 5.5 years, and exposure was as short as two weeks.
• Main results:
  • Pleuritic chest pain was the reason for presentation in 14 of the 22 men; 5 had no symptoms.
  • The erythrocyte sedimentation rate (ESR) was elevated in 15 of 21 patients; peripheral blood leucocytosis was noted in 7 of 20 patients.
  • The pleural fluid was frankly blood-stained in 13 men.
  • The Mantoux test was positive in 8 of 12 patients tested, but there was no other evidence of tuberculosis.
  • In 16 patients the mean time to resolution of the initial effusion was 4.3 months (range one to 12 months).
  • Eight patients had more than one pleural effusion. Six had one effusion on the other side only, one had one recurrence on the same side only, and one had one on the other side plus two on the same side.
  • Three patients continued to have persistent pleuritic pain after the initial effusion resolved.
  • No patient developed evidence of pleural or peritoneal mesothelioma or any other neoplasm during follow-up. Nineteen patients were followed from three months to 17.2 years (mean 6.3 years) after diagnosis.
  • The authors could not identify features at presentation that predicted further effusions or persistent pleuritic pain.
• The authors' conclusion: The authors concluded that clinical features at presentation varied widely. They also concluded that, in these cases, further effusions and persistent pleural pain were uncommon and malignant change had not yet been documented.
• Limitations the authors state:
  • Follow-up of some patients had not yet reached the 20 to 40 years after first exposure, the interval of peak mesothelioma incidence.
  • Whether asbestos-related pleural disease predisposed patients with viral infections to develop pleural effusions could not be determined from the available data.

Mines named here

Asbestos mines this study is about. Each mine's page says who ran it, when it worked, and what it produced.

• Wittenoom, Western Australia

All asbestos mines

Topics

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

Medical terms in this study, explained in our Lexicon: Benign Asbestos Pleural Effusion, Fibrosis, Exudate, Pleural Effusion, Mesothelioma, Neoplasm.

Related studies

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• Clinical Investigation of Benign Asbestos Pleural Effusion — N. Fujimoto, K. Gemba, et al. (2015)
• Pleural irregularities and mediastinal pleural involvement in early stages of malignant pleural mesothelioma and benign asbestos pleural effusion — K. Kato, K. Gemba, et al. (2016)
• Retrospective investigation on diagnostic process for benign asbestos pleural effusion (BAPE) using checklist — T. Kishimoto, N. Fujimoto, et al. (2020)
• A retrospective study on radiological findings of diffuse pleural thickening with benign asbestos pleural effusion in Japanese cases — T. Kishimoto, K. Kato, et al. (2022)
• Vascular endothelial growth factor in pleural fluid for differential diagnosis of benign and malignant origin and its clinical applications — A. Fiorelli, G. Vicidomini, et al. (2011)

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