Calcified plaques on mediastinal pleural reflections associated with asbestos dust exposure: four case reports

Our plain-English summary of Calcified plaques on mediastinal pleural reflections associated with asbestos dust exposure: four case reports, by A. Solomon, G.K. Sluis-Cremer, R.G. Thomas, et al (American Journal of Industrial Medicine, 1984).

The study

• Authors: A. Solomon, G.K. Sluis-Cremer, R.G. Thomas, V.M. Wright
• Journal: American Journal of Industrial Medicine
• Published: 1984;6(1):53-7
• Cited by: 1 article, 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. 000580).

In plain English

This article was a series of four case reports describing calcified pleural plaques seen on chest X-rays on the mediastinal pleural reflections (folds of the lung lining near the centre of the chest) in people exposed to asbestos dust. Case 1 was a woman who lived permanently in the North West Cape, an asbestos mining area. Her X-ray changes were assumed to be asbestos-related because environmental exposure there had been high. Case 2, an asbestos bag stamper exposed for 4 years, had X-rays 22 years later showing calcification of practically the whole pleural surface. Case 3, an asbestos mine labourer exposed for about 14 years, had no symptoms and showed a thick vertical calcified plaque beside the spine. Case 4 was a 56-year-old man with 5 years of asbestos exposure. His upper-left calcification was judged most likely asbestos-related, while scarring in his right upper lung could have come from tuberculosis, asbestos, or both. The authors concluded that no area of the pleura is immune to plaque formation.

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: Case reports (four cases)
• Who was studied: Four patients: a woman permanently resident in the North West Cape asbestos mining area (X-ray taken during a survey of asbestos dust-related disease), a male asbestos bag stamper, a labourer at an asbestos mine, and a 56-year-old man who had worked in gold and asbestos mines
• Exposure: Asbestos dust (fiber type not stated). Case 1: environmental exposure, described as high in the 1960s. Case 2: 4 years of continuous work as an asbestos bag stamper in an extremely dusty environment. Case 3: about 14 years of exposure between 1934 and 1964, working underground and on the surface at an asbestos mine. Case 4: 5 years of asbestos exposure, plus work in gold mines.
• Main results:
  • Case 1 (woman, environmental exposure): diffuse calcified plaques on both sides of the anterior mediastinal pleura, plus an uncalcified plaque in the left armpit region
  • Case 2 (bag stamper): X-rays 22 years after a 4-year exposure showed extensive calcification on both sides involving the anterior mediastinal pleural reflections, the parietal and diaphragm surfaces, and a calcified plaque on the lesser fissure
  • Case 3 (asbestos mine labourer): an oblique X-ray in 1982 showed a thick vertical calcified plaque on the paravertebral pleural reflection (beside the spine) and a large calcified plaque on the left diaphragm
  • Case 3 had no symptoms and no clinical evidence of disability
  • Case 4 (56-year-old man): a 1979 X-ray showed calcification of the left posterior mediastinal pleura, which the authors judged most likely to follow asbestos exposure
  • Case 4 also had fine irregular lung opacities at the lung bases that suggested parenchymal asbestosis
• The authors' conclusion: The authors concluded that no area of the pleural surface, parietal or visceral, is immune to plaque formation. They added that knowing the anatomy of the mediastinal pleural reflections allows plaques in unusual sites to be recognised, and that careful examination of these reflections on asbestos workers' X-rays might reveal calcifications even where no pleural calcification appears elsewhere.
• Limitations the authors state:
  • In Case 4, the scarring in the right upper lung could have been caused by tuberculous infection, by asbestos dust exposure, or by both
  • In Case 1, the link to asbestos was assumed from the high environmental exposure in the area, not established for the individual

Topics

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

Related studies

• Calcified interlobar pleural plaques: visceral pleural involvement due to asbestos — E.N. Sargent, J.S. Felton, et al. (1981)
• Calcified plaque in the superior portion of the major fissure. An unusual manifestation of asbestos exposure — S.B. Rupp, H. Jolles (1989)
• Pleural plaques: a signpost of asbestos dust inhalation — E.N. Sargent, G. Jacobson, et al. (1977)
• Subpleural fat pads in patients exposed to asbestos: distinction from non-calcified pleural plaques — E.N. Sargent, W.D. Boswell, et al. (1984)
• Calcifying fibrous pseudotumor of mediastinum--a case report — H.S. Jeong, G.K. Lee, et al. (1997)
• Rosai-Dorfman disease presenting as a solitary mediastinal mass — A.I. Hida, S. Yagi, et al. (2009)

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