Bilateral pleural thickening: a manifestation of asbestos dust exposure

Our plain-English summary of Bilateral pleural thickening: a manifestation of asbestos dust exposure, by E.N. Sargent, J. Gordonson, G. Jacobson, et al (AJR. American Journal of Roentgenology, 1978).

The study

• Authors: E.N. Sargent, J. Gordonson, G. Jacobson, W. Birnbaum, M. Shaub
• Journal: AJR. American Journal of Roentgenology
• Published: 1978;131(4):579-85
• Cited by: 35 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. 001081).

Abstract

Bilateral pleural thickening in a relatively asymptomatic patient without evidence of pulmonary disease is frequently a manifestation of asbestos dust exposure, particularly when it is localized or in the form of a noncalcified pleural plaque. Bilateral pleural thickening will be discovered with increasing frequency if specifically searched for on every radiograph. This radiographic finding is suggested as a more realistic indication of asbestos dust exposure, particularly when correlated with a complete occupational history.

In plain English

This preliminary study came from radiologists at Los Angeles County-University of Southern California Medical Center. While studying how pleural thickening shows on chest X-rays, the authors found 36 patients with clinically unsuspected asbestos dust exposure in one year, against 10 cases diagnosed in the preceding 4 years. Each was later confirmed by occupational history. Exposures came roughly equally from shipyard work and building-trades jobs. Thickening was graded by width: A up to 5 mm, B 5 to 10 mm, C over 10 mm. Of the 36, 32 had bilateral pleural thickening, 13 of them with no other finding, and none had thickening on one side only. Grade A was most common (67%). Grade B occurred in 24% and was almost three times as frequent on the right. Thickening mostly lay at the fifth through eighth ribs and spared the lung tops and costophrenic angles. Its extent and severity did not correlate with how long, or how long ago, patients were exposed. The authors concluded that unexpected bilateral noncalcified localized pleural thickening or plaques, with no other evidence of disease in a relatively symptom-free patient, signal that the patient may have been exposed to asbestos dust.

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: Preliminary radiographic case series (single institution)
• Who was studied: 36 patients with clinically unsuspected asbestos dust exposure found in a single year at the authors' institution (Department of Radiology, Los Angeles County-University of Southern California Medical Center), compared with 10 cases diagnosed there in the preceding 4 years; all later substantiated by a positive occupational history
• Exposure: Occupational asbestos dust exposure, roughly evenly divided between shipyard workers and miscellaneous building-trades occupations; fiber types and doses not given
• Main results:
  • Maximum pleural thickness was graded under the 1971 International Labor Organization classification: grade A up to 5 mm, grade B 5 to 10 mm, grade C over 10 mm in width
  • 32 of the 36 patients had bilateral pleural thickening
  • 13 patients had bilateral pleural thickening alone (out of 36 total)
  • No patient had unilateral pleural thickening
  • Grade A thickening was the most common (67%) and involved both sides of the chest with equal frequency
  • Grade B thickening occurred in 24% of cases and was almost three times as frequent on the right as on the left
  • Thickening most frequently involved the fifth through eighth ribs and interspaces
  • No involvement of the lung apices or costophrenic angles was seen
  • Maximum thickness was at the fifth to eighth ribs and interspaces in all but six cases
  • The extent and severity of the pleural thickening did not correlate with total duration of exposure or time elapsed since exposure
• The authors' conclusion: The authors concluded that an unexpected finding of bilateral noncalcified localized pleural thickening or plaques on routine radiographs, with no other evidence of disease in a relatively asymptomatic patient, is a signal that the patient may have been exposed to asbestos dust
• Limitations the authors state:
  • Oblique X-ray views, which help detect and measure costal pleural thickening, were not used because they were not obtained routinely or available in all cases
  • The study made no effort to determine the prevalence of asbestosis at the medical center
  • The frequency of bilateral pleural plaques in populations without occupational exposure is unknown

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: Bilateral, Pleural Thickening, Pleural Plaques, Occupational History.

Related studies

• Roentgenographic manifestations and pulmonary function effects of asbestos-induced pleural thickening — L. Rosenstock (1991)
• Pleural plaques: a signpost of asbestos dust inhalation — E.N. Sargent, G. Jacobson, et al. (1977)
• A survey of pleural thickening: its relation to asbestos exposure and previous pleural disease — (1972)
• Calcified plaque in the superior portion of the major fissure. An unusual manifestation of asbestos exposure — S.B. Rupp, H. Jolles (1989)
• Pleural thickening: its significance and relationship to asbestos dust exposure — S.M. Albelda, D.M. Epstein, et al. (1982)
• Asbestos-related pleural thickening: effect of threshold criteria on interpretation — R. Greene, C. Boggis, et al. (1984)

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