Inflammation of the visceral pleura, a nonspecific asbestos-related pleural reaction: chest radiograph and computed tomograph correlation

Our plain-English summary of Inflammation of the visceral pleura, a nonspecific asbestos-related pleural reaction: chest radiograph and computed tomograph correlation, by A. Solomon, A.H. Rubin, J. Bar-Ziv, et al (American Journal of Industrial Medicine, 1991).

The study

• Authors: A. Solomon, A.H. Rubin, J. Bar-Ziv, R. Carel
• Journal: American Journal of Industrial Medicine
• Published: 1991;20(1):49-55
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Nonspecific pleuritis, i.e., inflammation of the visceral pleura, is recognized by the presence of pleural strands on the routine posteroanterior chest radiograph. The computed tomograph counterparts of these strands are seen as interlobular septal intrusions and lenticular or wedge-shaped subpleural opacities. The pleural reaction is nonspecific and may be found with asbestos exposure, traumatic hemorrhagic effusions, pulmonary embolism, viral pleurisy, malignant pleural effusions, and lupus or rheumatoid effusions. The asbestos-related pleural changes may be found alone or in association with parietal pleural plaque formation or with asbestotic lung fibrosis.

In plain English

This case series described 14 asbestos-exposed workers whose routine chest X-rays showed pleural strands. These are thin lines that the authors linked to inflammation of the lung's outer covering (visceral pleuritis). Eleven were electricians and two were maintenance workers in a refinery and in shipyards, all with significant asbestos exposure in excess of 10 years previously. The remaining person, a shipyard maintenance worker, had high asbestos dust exposure for 5 years. The article did not name the fiber types these 14 workers were exposed to. All the workers then had chest CT scans. Fine strands on X-ray matched, on CT, a thickening of the thin partitions inside the lung (interlobular septal thickening). Coarser strands appeared as wedge-shaped or lens-shaped masses just under the lung surface. The pleuritis occurred alone, or together with calcified or non-calcified pleural plaques, sometimes also with asbestotic lung fibrosis. The authors concluded that these CT opacities may represent visceral pleural "fascicles". They also concluded that the terms pseudotumor or lobular atelectasis should be reserved for cases meeting all its criteria. They noted that accurate information on the median and shortest durations of exposure was unavailable.

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 comparing chest radiograph and computed tomography (CT) findings
• Who was studied: 14 asbestos-exposed workers with pleural strands on routine posteroanterior chest radiographs: 11 electricians, two maintenance personnel working in a refinery and in shipyards, and one shipyard maintenance worker; ages 45 to 65 years, mean 56 years. The article does not state where or when the workers were seen.
• Exposure: Occupational asbestos exposure; the fiber type for these workers is not stated. Thirteen workers had significant asbestos exposure in excess of 10 years previously; one shipyard maintenance worker had exposure to high dust levels of asbestos for 5 years.
• Main results:
  • In these workers, minor pleural strands on the chest radiograph corresponded on CT to isolated interlobular septal thickening with intrusions, alone or with parietal plaques.
  • Coarser strands on the chest radiograph had more pronounced CT counterparts, seen as wedge-shaped or lenticular subpleural masses.
  • Among the 14 workers, pleuritis occurred either as an isolated finding or together with calcified or non-calcified pleural plaques, alone or with asbestotic lung fibrosis.
  • In some cases, the strand-related changes were not accompanied by other evidence of parenchymal fibrosis in lung regions free from pleural changes.
  • Crossed strands resembling "crow's feet" were not seen in this series.
• The authors' conclusion: The authors concluded that subpleural lenticular and wedge-shaped CT opacities in asbestos-exposed persons may represent visceral pleural "fascicles" seen as strands on routine chest radiographs. They also concluded that the terms pseudotumor or lobular atelectasis should be reserved for cases meeting all criteria of lobular atelectasis.
• Limitations the authors state:
  • Accurate information on the median and shortest durations of asbestos exposure was unavailable.

Topics

Medical terms in this study, explained in our Lexicon: Inflammation, Visceral Pleura, Chest X-Ray, Asbestos Exposure, Pleurisy, Pleural Effusion, Pleural Plaques, Fibrosis.

Related studies

• 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)
• The usefulness of computed tomography in detecting asbestos-related pleural abnormalities in people who had indeterminate chest radiographs: the Libby, MT, experience — O.I. Muravov, W.E. Kaye, et al. (2005)
• High resolution computed tomography and lung function in asbestos-exposed workers with normal chest radiographs — C.A. Staples, G. Gamsu, et al. (1989)
• Asbestos-related lesions of the pleura: parietal plaques compared to diffuse thickening studied with chest roentgenography, computed tomography, lung function, and gas exchange — G. Hillerdal, P. Malmberg, et al. (1990)
• Agreement between chest radiography and high-resolution computed tomography in diagnosing dust-related interstitial lung fibrosis — R.R. Tiwari (2015)
• Chronic follicular pleuritis: a B cell-rich form of nonspecific pleuritis/fibrosis — S.A. Yousem (2019)

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