Fibrosing pleuritis with extrathoracic extension

Our plain-English summary of Fibrosing pleuritis with extrathoracic extension, by B.I. Hoffbrand, M.R. Hetzel, P. Goldstraw (Journal of the Royal Society of Medicine, 1985).

The study

• Authors: B.I. Hoffbrand, M.R. Hetzel, P. Goldstraw
• Journal: Journal of the Royal Society of Medicine
• Published: 1985;78(11):953-4
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001255).

In plain English

This was a case report about one man treated in London. He was a 39-year-old company director who presented in April 1982 with left-sided pleurisy. He smoked 60 cigarettes a day and had worked with asbestos-containing insulating materials as a carpenter in the building trade from age 15 to 30, which the authors described as mild asbestos exposure. Thickening of the lining of his left lung (pleural fibrosis) progressed, and in September 1982 surgeons removed it (decortication). The fibrosis was mainly on the chest-wall layer of the pleura, and tissue examination was unremarkable. His chest pain returned in autumn 1983; by January 1984 it had worsened and a lump about 5 x 7.6 cm had appeared under the skin along the line of his earlier surgery. Treatment with the steroid prednisolone shrank the lump very rapidly. Symptoms returned in December 1984 and improved when the dose was raised. The authors concluded that his illness was largely compatible with asbestos-associated pleural disease, but that its rapid progression, spread outside the chest, and response to steroids made the case exceptional.

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 39-year-old man, a company director, seen in London, who presented in April 1982 and was followed to late 1984
• Exposure: Occupational work with asbestos-containing insulating materials as a carpenter in the building trade from age 15 to 30, described by the authors as mild exposure. He also smoked 60 cigarettes per day. The article does not state the fiber type.
• Main results:
  • Progressive left pleural thickening led to left thoracotomy and decortication in September 1982. The fibrosis was mainly parietal, and histology was unremarkable with normal underlying lung.
  • He remained well until autumn 1983, when left chest pain returned with more cough and sputum and with breathlessness.
  • By January 1984 these symptoms were worse, and a non-tender subcutaneous mass about 2 x 3 inches (5 x 7.6 cm) had appeared on the front of the chest in the line of the previous thoracotomy.
  • At that time the ESR (a blood test for inflammation) was 59 mm in the first hour, compared with 25 mm at first presentation.
  • Prednisolone treatment led to very rapid shrinkage of the subcutaneous lump and improvement in his other symptoms.
  • After a relapse in December 1984, his symptoms responded to a higher prednisolone dose, and he was reported well on 10 mg/day.
• The authors' conclusion: The authors concluded that the patient's illness was largely compatible with asbestos-associated pleural disease (together with chronic bronchitis). They added that its rapid progression, extension outside the chest, and sensitivity to corticosteroids made the case exceptional. They stated that the nature of 'cryptogenic fibrosing pleuritis' and its relationship to this patient's disease remained unclear.

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