Clinical presentation of asbestosis with intractable pleural pain in the adult child of a taconite miner and radiographic demonstration of the probable pathology causing the pain

Our plain-English summary of Clinical presentation of asbestosis with intractable pleural pain in the adult child of a taconite miner and radiographic demonstration of the probable pathology causing the pain, by M.R. Harbut, C. Endress, J.J. Graff, et al (International Journal of Occupational and Environmental Health, 2009).

The study

• Authors: M.R. Harbut, C. Endress, J.J. Graff, C. Weis, H. Pass
• Journal: International Journal of Occupational and Environmental Health
• Published: 2009;15(3):269-73
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Taconite, although not classified by the United States Government as asbestos or asbestiform material, has been associated with asbestos-related diseases. The mineral is used in the production of steel and as a road-patch material and is mined in Michigan and Minnesota. This report describes the case of a middle-aged Caucasian woman with exposure to taconite mining dust from her miner father's clothing in childhood with a resultant presentation consistent with asbestosis and intractable pleural pain. Intractable pleural pain has been described in asbestos-exposed patients with theorized etiologies. However, no in vivo reported mechanism has demonstrated a plausible, anatomically apparent mechanism for the pain. We utilize an application of the Vitrea software for enhancement of high-resolution computerized tomography which demonstrates at least one likely mechanism for intractable pleural pain.

In plain English

This article was a case report about one patient, a 48-year-old Caucasian woman referred to the National Center for Vermiculite and Asbestos-Related Cancers at the Karmanos Cancer Institute in Detroit, Michigan. Her right-sided chest pain had increased over 31 years and had needed narcotics for three years. Her father worked as a taconite miner at the Tilden II mine in L'Anse, Michigan, from 1962 to 1969 and came home without showering or changing clothes. She had also attended and later worked in a local high school building that contained asbestos. Breathing tests showed a persistently reduced diffusion capacity. Yearly CT scans showed pleural, diaphragmatic and pericardial plaques and lung fibrosis that progressed. Using Vitrea software to enhance the scans, the authors reported progressive rib erosion matching the painful areas. Right-side plaque volume rose from 116.9 to 160.6 cubic centimeters between July 2005 and July 2008. The authors concluded that she most likely developed asbestosis, pleural plaques and intractable pleural pain from taconite-mining dust carried home on her father's clothing. They also noted that unenhanced CT readings are not always reproducible.

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 (one patient)
• Who was studied: One 48-year-old Caucasian woman, a school librarian in the taconite mining region of Michigan's Upper Peninsula, referred to the National Center for Vermiculite and Asbestos-Related Cancers at the Karmanos Cancer Institute, Detroit, Michigan; followed with yearly tests over about four years (2004 to 2008)
• Exposure: Taconite mining dust carried home in childhood on the clothing of her father, who worked as a taconite miner at the Tilden II mine, L'Anse, Michigan, from 1962 to 1969. She also attended high school (1968 to 1972) and worked (1982 to 1994) in an asbestos-containing local high school building.
• Main results:
  • Repeated breathing tests in the patient showed a persistently reduced diffusion capacity, which the authors described as consistent with asbestosis.
  • Yearly high-resolution CT scans of the patient showed bilateral calcified, partially calcified and noncalcified pleural plaques, diaphragmatic and pericardial plaques, and pulmonary fibrosis consistent with asbestosis, with progression over time.
  • On software-enhanced CT images of the patient, the authors found progressive erosion of the ribs corresponding to the painful area on the right side of her chest and to the emerging pain on the left side.
  • In the patient's right chest, pleural plaque volume increased from 116.9 cm3 to 160.6 cm3 from July 2005 to July 2008.
  • In the patient, right-side pleural plaque surface area increased from 490.3 cm2 to 767.6 cm2, and left-side plaque surface area increased from 314.8 cm2 to 486.2 cm2.
  • From 2005 to 2008, the patient's plaque-to-lung surface area rose from 37% to 57% on the right side and from 24% to 37% on the left side.
  • Nuclear bone scans of the patient taken four years apart showed no evidence of a metastatic or similarly isotope-avid process, and other causes of pain and shortness of breath were ruled out.
• The authors' conclusion: The authors concluded that the patient most likely developed asbestosis, pleural plaques and intractable pleural pain from inhaling taconite-mining dust carried home by her father. They proposed that the growing plaques, pressing on nearby tissue and causing bone erosion, were a probable mechanism for her pain. They also argued that the definition of asbestos should be reevaluated.
• Limitations the authors state:
  • The authors noted that readings of this type of progression on unenhanced CT are not always reproducible. They stated that a reliability (inter-reader comparison) study of the enhancement software was still being planned.
  • The authors stated there may be other mechanisms for the pain besides the one they demonstrated.
  • The authors noted that the mineral makeup of the Minnesota Iron Range and the Michigan Negaunee Iron Formation likely varies. They also noted that emissions test reports from the Tilden Mine Company did not report asbestiform fibers.

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: Taconite, Pathology, Asbestiform.

Related studies

• A case-control study of mesothelioma in Minnesota iron ore (taconite) miners — C.S. Lambert, B.H. Alexander, et al. (2016)
• An overview of the risk of lung cancer in relation to exposure to asbestos and of taconite miners — G. Berry, G.W. Gibbs (2008)
• Amphibole fibers in a taconite mine and in the lungs of the miners — B. Gylseth, T. Norseth, et al. (1981)
• Mesothelioma in iron ore (taconite) miners — D. Mirabelli (2016)
• Risk assessment due to environmental exposures to fibrous particulates associated with taconite ore — R. Wilson, E.E. McConnell, et al. (2008)
• Respiratory effects of exposure to dust in taconite mining and processing — T.C. Clark, V.A. Harrington, et al. (1980)

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