Case report: asbestos related pericardial disease

Our plain-English summary of Case report: asbestos related pericardial disease, by M. Cooper, K. Johnson, D.J. Delany (Clinical Radiology, 1996).

The study

• Authors: M. Cooper, K. Johnson, D.J. Delany
• Journal: Clinical Radiology
• Published: 1996;51(9):656-7
• Type of article: Case report
• Read it: PubMed · Publisher

In plain English

This case report described one patient. The patient was a 55-year-old retired builder's labourer with diabetes, chronic airways disease and known pleural thickening, admitted with severe heart failure affecting both sides of the heart. An echocardiogram was reported as showing constrictive pericarditis. Chest X-ray and high-resolution CT showed pleural plaques and thin calcification of the pericardium (the sac around the heart) from the apex to the base of the heart, with no CT evidence of pericardial inflammation or fluid. Pressures inside the heart were greatly raised. The coronary arteries were normal, and poor movement of the left ventricle was attributed to restriction by the thickened, calcified pericardium. The patient developed bronchopneumonia and died. The post mortem confirmed the pericardial calcification and reported its microscopic appearance as identical to the pleural disease. It found asbestos bodies in the lung periphery but no evidence of asbestosis or of previous tuberculosis. The authors could not quantify the asbestos exposure and did not name a fiber type. They concluded the pericardial disease was secondary to asbestos exposure. They recommended inspecting the pericardium on all HRCT scans done for asbestos-related lung disease.

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 report (single patient)
• Who was studied: One 55-year-old retired builder's labourer with non-insulin dependent diabetes, chronic airways disease and pleural thickening. He was admitted with severe biventricular failure and transferred to the Wessex Cardiothoracic Centre (UK).
• Exposure: Asbestos exposure in a retired builder's labourer. The degree of exposure was not quantified and no fiber type was stated.
• Main results:
  • The chest radiograph showed moderate pleural plaques, calcified over the diaphragmatic surface, and thin curvilinear calcification over the right ventricle and the anterolateral wall of the left ventricle.
  • HRCT showed the pericardial calcification extending from the cardiac apex to the base of the heart.
  • HRCT showed no CT evidence of pericardial inflammation or effusion.
  • At cardiac catheterisation the pressures were grossly elevated: mean right atrial pressure 47 mmHg, pulmonary capillary wedge pressure 48 mmHg, end diastolic RV pressure 49 mmHg and end diastolic LV pressure 38 mmHg. These pressures were not thought characteristic of either constriction or restriction because of the degree of LV dysfunction.
  • Coronary arteriography was normal. The LV dysfunction was considered to be due to poor movement of the apex and anterolateral wall, restricted by the thickened and calcified pericardium.
  • The patient became feverish and developed bronchopneumonia, then had cardiovascular collapse and died.
  • The post mortem confirmed thin pericardial calcification (thickness printed as '2 4 mm') and fibrous epithelial plaques strongly adherent to the epicardium. The microscopic appearance of the pericardial disease was reported as identical to that of the pleural disease.
  • At post mortem, asbestos bodies were found in the lung periphery but there was no evidence of asbestosis.
  • The case history recorded no history of tuberculosis.
  • The post mortem found no evidence of previous tuberculosis.
• The authors' conclusion: The authors considered the calcific pericardial disease and constrictive pericarditis to be secondary to asbestos exposure, confirming the appearance described by Fischbein et al. They suggested that recognising pericardial involvement in asbestos-related chest disease is important because early intervention may be beneficial. They recommended that the pericardium be specifically inspected on all HRCT scans done to assess asbestos-related lung disease.
• Limitations the authors state:
  • The authors were unable to quantify the degree of the patient's asbestos exposure.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial.

Related studies

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• Pericardial mesothelioma presenting as left atrial thrombus in a patient with mitral stenosis — Y. Miyamoto, S. Nakano, et al. (1996)
• Recurrent pericardial effusion with pericardial amyloid deposition: a case report and literature review — H. Itagaki, T. Yamamoto, et al. (2020)
• A case of primary pericardial mesothelioma detected by 18F-FDG PET/CT — F. Aga, Y. Yamamoto, et al. (2012)
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