Computed tomography in pulmonary pseudotumors and their relation to asbestos exposure

Our plain-English summary of Computed tomography in pulmonary pseudotumors and their relation to asbestos exposure, by U. Tylén, U. Nilsson (Journal of Computer Assisted Tomography, 1982).

The study

• Authors: U. Tylén, U. Nilsson
• Journal: Journal of Computer Assisted Tomography
• Published: 1982;6(2):229-37
• Cited by: 53 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. 001790).

Abstract

Twelve patients, nine of whom had histories of exposure to asbestos, were evaluated by chest roentgenography and computed tomography because of a pulmonary mass lesion. The lesion consisted of condensed atelectatic lung parenchyma surrounded by marked thickening of the pleura--a pulmonary pseudotumor. In most patients, the mass lesion was only part of a more extensive disease process with pleural plaques and parenchymal fibrosis. Computed tomography demonstrated the full extent of disease better than chest roentgenograms. Asbestos is stressed as a possible causative factor of these mass lesions.

In plain English

This report from a radiology department in Lund, Sweden, described 12 patients (10 men, 2 women, aged 50 to 74) with a lung mass the authors called a "pseudotumor": collapsed lung tissue surrounded by markedly thickened pleura. Occupational asbestos exposure (fiber types not named) was documented in 9 of the 12. All had chest X-rays and computed tomography (CT). Pleural plaques were found in all but two. CT showed lung fibrosis in nine patients; the discussion compared this with two on chest X-rays, but the chest X-ray results reported marked fibrosis in three and less marked fibrosis in two. In two patients examined for a one-sided lesion, CT found a similar lesion on the other side. A needle biopsy wrongly suggested cancer in one patient, as surgery later showed; five other biopsies were inconclusive. Of four patients who had surgery, one had lung tissue removed that showed no cancer. The authors concluded that CT showed the full extent of disease better than chest X-rays, and that their findings strongly supported the suggestion that asbestos may be a common cause of these lesions.

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 series (radiological report of 12 patients)
• Who was studied: 12 patients (10 men and 2 women) aged 50 to 74 years (mean 62), each with a pulmonary mass lesion, examined at the Department of Diagnostic Radiology, University Hospital, Lund, Sweden. Dates of study are not given.
• Exposure: Occupational asbestos exposure, documented in 9 of the 12 patients. Fiber types are not named. Jobs mentioned in figure captions include a plumber exposed for 7 years and a carpenter. One illustrated patient had no known asbestos exposure.
• Main results:
  • Occupational exposure to asbestos was documented in 9 of the 12 patients.
  • Pleural plaques were demonstrated in all but two patients. CT did not show plaques in the two patients without plaques on chest roentgenograms.
  • The Discussion states that fibrosis of the lung parenchyma was demonstrated in nine patients by CT, compared with two by chest roentgenography.
  • The chest film Results, by contrast, report marked parenchymal fibrosis (a coarse reticulonodular pattern) in three patients and less marked fibrosis in two. The article's chest-film counts are therefore not consistent.
  • In two patients evaluated because of a lesion on one side, CT found a similar lesion on the opposite side.
  • Fine needle biopsy was done in six patients. In one, a diagnosis of malignancy was made that was later proven incorrect at operation. In the other five, biopsy material was nonconclusive.
  • Four patients had exploratory thoracotomy. Findings included pleural thickening with adhesions. In one patient, wedge resection showed no evidence of malignancy at pathologic examination.
  • Pleural fluid was ever demonstrated in only one patient in the series.
  • Previous chest examinations were available in nine patients. In four of them the pseudotumor was already evident, and in two the lesions had progressed slowly.
• The authors' conclusion: The authors concluded that CT demonstrated the full extent of disease better than chest roentgenograms. They stressed asbestos as a probable causative factor of these mass lesions, writing that their findings strongly support the suggestion that asbestos may be a common causative factor in the development of pseudotumors.
• Limitations the authors state:
  • The authors state that CT may not separate the visceral pleura from the parietal pleura.
  • The authors state that whether CT can also detect early fibrosis remains to be clarified.
  • The authors state that fine needle biopsy material from these lesions was sparse, and that malignancy can never be excluded by fine needle biopsy alone.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Parenchyma, Pleura, Pleural Plaques, Parenchymal Fibrosis.

Related studies

• Pulmonary function, smoking habits, and high resolution computed tomography (HRCT) early abnormalities of lung and pleural fibrosis in shipyard workers exposed to asbestos — S. Neri, P. Boraschi, et al. (1996)
• Findings from high resolution computed tomography of the lung and pleura of symptom free workers exposed to amosite who had normal chest radiographs and pulmonary function tests — S. Neri, A. Antonelli, et al. (1994)
• Computed tomography in pulmonary asbestosis — D. Katz, L. Kreel (1979)
• Psychological impact of computed tomography screening for lung cancer and occupational pulmonary disease among asbestos-exposed workers — T. Vierikko, S. Kivistö, et al. (2009)
• The comparison of high-resolution computed tomography findings in asbestosis and idiopathic pulmonary fibrosis — M. Akira, K. Morinaga (2016)
• Measurement of lung density by x-ray computed tomography. Relation to lung mechanics in workers exposed to asbestos cement — P. Wollmer, K. Jakobsson, et al. (1987)

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