Constrictive pericarditis in a patient with fiberglass lung disease: a case report

Our plain-English summary of Constrictive pericarditis in a patient with fiberglass lung disease: a case report, by C.Y. Hsu, H.Y. Chen, M.S. Hsieh, et al (BMC Pulmonary Medicine, 2024).

The study

• Authors: C.Y. Hsu, H.Y. Chen, M.S. Hsieh, Y.H. Lee, C.C. Lan, M.C. Yang
• Journal: BMC Pulmonary Medicine
• Published: 2024;24(1):382
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Fiberglass has a larger aerodynamic diameter and is less likely to be inhaled into the lungs. Further, it will be cleared even if it is mechanically broken into smaller pieces and inhaled into the lungs. Fiberglass lung disease has been well documented if long term exposure but was thought reversible and would not cause severe diseases. The diagnosis of fiberglass lung disease depends on exposure history and histopathological findings. However, the exact occupational exposure history is often difficult to identify because mixed substance exposure often occurs and fiberglass disease is not as well-known as asbestosis.

Case Presentation: A 66-year-old man had unexplained transudative pericardial effusion requiring pleural pericardial window operation twice at another medical center where asbestosis was told because of his self-reported long-term asbestosis exposure and the histopathological finding of a ferruginous body in his lung. Constrictive pericarditis developed two years later and resulted in congestive heart failure. Radical pericardiectomy combined with lung biopsy was performed following chest computed tomography imaging and the transudative nature of pericardial effusion not compatible with asbestosis. However, the histopathologic findings of his lung and pericardium at our hospital only showed chronic fibrosis without any asbestosis body. The patient's lung was found to be extremely fragile during a lung biopsy; histopathologic specimens were reviewed, and various fragments of fiberglass were found in the lung and pericardium. The patient's occupational exposure was carefully reevaluated, and he restated that he was only exposed to asbestosis for 1-2 years but was heavily exposed to fiberglass for more than 40 years. This misleading exposure history was mainly because he was only familiar with the dangers of asbestos. Since most fiberglass lung diseases are reversible and the symptoms of heart failure resolve soon after surgery, only observation was needed. Ten months after radical pericardiectomy, his symptoms, pleural effusion, and impaired pulmonary function eventually resolved.

Conclusion: Fiberglass could cause inflammation of the pericardium, resulting in pericardial effusion and constrictive pericarditis, which could be severe and require radical pericardiectomy. Exact exposure history and histopathological examinations are the key to diagnosis.

© 2024. The Author(s).

In plain English

This case report described one man treated at Taipei Tzu Chi Hospital in Taiwan. He was a 66-year-old ex-smoker who worked as a medical equipment operator. At another hospital he was treated twice for fluid around the heart and told he had asbestosis, based on his reported long-term asbestos exposure and a ferruginous body found in his lung. He later developed constrictive pericarditis, and in October 2021 he had his pericardium removed (radical pericardiectomy) and an open lung biopsy. His lung and pleura showed mild fibrosis but no asbestos or ferruginous bodies. The authors hypothesized that translucent particles seen under polarized microscopy were fiberglass. Re-examined samples from the other hospital showed one ferruginous body and no asbestos bodies. When asked again, the patient said he was only slightly exposed to asbestos during the first 3 years but heavily exposed to fiberglass for 40 years. He was diagnosed with fiberglass lung disease, not asbestosis. Ten months after surgery his symptoms had resolved. The authors concluded that fiberglass can cause pericardial inflammation leading to constrictive pericarditis.

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 66-year-old male ex-smoker who worked as a medical equipment operator. He presented at Taipei Tzu Chi Hospital, Taiwan, on July 30, 2021, after earlier treatment at another hospital.
• Exposure: The patient first self-reported heavy asbestos exposure for 40 years. When asked again, he reported only slight asbestos exposure during the first 3 years and heavy fiberglass exposure over the past 40 years.
• Main results:
  • At the other hospital, asbestosis was diagnosed because of his self-reported long-term asbestos exposure and a ferruginous body found in his lung.
  • He underwent radical pericardiectomy with an open lung biopsy on October 13, 2021.
  • Lung pathology from the authors' hospital showed mild interstitial fibrosis of the lung and pleura, with no asbestos or ferruginous bodies.
  • The pericardium was extremely thickened, and the epicardium contained a few tiny fragments described as fiberglass.
  • Re-examined specimens from the other hospital showed only one ferruginous body and no asbestos bodies.
  • The authors hypothesized that the translucent particles seen under polarized microscopy were fiberglass.
  • The patient was diagnosed with fiberglass lung disease, not asbestosis.
  • Ten months after radical pericardiectomy, his symptoms, pleural effusion and pulmonary function had resolved.
• The authors' conclusion: The authors concluded that fiberglass can cause inflammation of the pericardium, causing pericardial effusion and then constrictive pericarditis severe enough to need radical pericardiectomy. They also concluded that a careful review of exposure history and histopathology is needed for an exact diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Exposure History, Occupational Exposure History, Pericardial Effusion, Pericardial, Ferruginous body, Pericardiectomy, Biopsy, Pericardium.

Related studies

• Constrictive pericarditis after left extrapleural pneumonectomy and radiotherapy for malignant mesothelioma — E.J. Hickey, A.A. Khan, et al. (2007)
• Pericardiectomy for treatment of neoplastic constrictive pericarditis — F. Buyukbayrak, E. Aksoy, et al. (2014)
• Asbestos induced pericardial effusion and constrictive pericarditis — D. Davies, M.I. Andrews, et al. (1991)
• Chronic constrictive pericarditis associated with asbestosis — L. Fischbein, M. Namade, et al. (1988)
• 18F-FDG PET/CT Revealing Constrictive Pericarditis as the Only Manifestation of Malignant Mesothelioma — J.P. Edel, H. Balink (2019)
• A case of pleural mesothelioma with effusive-constrictive pericarditis — N.A. Weir, B. Gerstenhaber (2001)

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