Marked ventilation impairment due to progression of diffuse pleural thickening after cardiac surgery

Our plain-English summary of Marked ventilation impairment due to progression of diffuse pleural thickening after cardiac surgery, by T. Touma, R. Taira, T. Makida, et al (Radiology Case Reports, 2022).

The study

• Authors: T. Touma, R. Taira, T. Makida, K. Oshiro, T. Miyara, Y. Taba
• Journal: Radiology Case Reports
• Published: 2022;17(1):1-4
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 64-year-old Japanese man presented with dyspnea and shortness of breath during exertion. Chest computed tomography revealed bilateral pleural effusion. He was drowsy because of CO2 storage and died due to ventilatory impairment. His past medical history included a thymectomy and adjuvant radiotherapy with thymoma. He had undergone cardiac surgery and permanent pacemaker implantation. The autopsy examination revealed extensive bilateral pleural adhesions and diffuse visceral pleural thickening. An inspection of multiple lung sections failed to detect any asbestos body formation or mesothelioma. The patient's pleural effusion and diffuse pleural thickening may have exacerbated after cardiac surgery. In this case, the progression and pathophysiology of the pleural thickening could be traced by imaging and an autopsy, and we were able to estimate the factors that exacerbated the pleural thickening and ventilation impairment.

© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.

In plain English

This case report described one 64-year-old Japanese man with about a year of breathlessness on exertion. Three years earlier he had undergone coronary bypass surgery and replacement of his aortic and mitral valves. Thirty years earlier he had had a thymoma (a tumor of the thymus gland) removed, followed by radiotherapy. The authors reported that he had never been directly or indirectly exposed to asbestos. A CT scan from before the heart surgery showed no pleural thickening or fluid. Later scans showed fluid around both lungs and diffuse thickening of the pleura, the lining around the lungs. Fluid drained from the left side contained no cancer cells. His breathing failed, carbon dioxide built up in his blood, and he died on day 90 in hospital. At autopsy the pleura was thickened with increased fibrous tissue. Light microscopy of multiple lung sections found no asbestos bodies and no mesothelioma. The authors speculated that the heart surgery may have promoted the thickening. They said the earlier radiation could not be ruled out and that several factors may have contributed.

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, including autopsy)
• Who was studied: One 64-year-old Japanese man admitted to the authors' hospital (Okinawa Prefectural Nanbu Medical Center, Okinawa, Japan)
• Exposure: No asbestos exposure, as reported by the authors. The factors considered were prior cardiac surgery (bypass grafting and aortic and mitral valve replacement 3 years earlier), a pacemaker implanted 2 years earlier, and thymectomy with radiotherapy for thymoma 30 years earlier.
• Main results:
  • The CT scan done 3 years earlier, before the cardiac surgery, showed no pleural thickening or pleural effusion.
  • Respiratory function tests before the cardiac surgery measured 62% vital capacity and 82% forced expiratory volume in 1 second.
  • 920 mL of pleural fluid was drained. No malignant cells were found, and the adenosine deaminase level was normal.
  • On day 68 of hospitalization a blood gas test showed a PCO2 of 76 mm Hg, with narcosis (impaired consciousness) from carbon dioxide retention.
  • The patient died on day 90 of hospitalization.
  • Autopsy showed diffuse pleural thickening of 3 mm in the lower right lung field, with partial thickening of the left pleura and pericardium.
  • Microscopy confirmed paucicellular hyaline collagen plaques in the pleura.
  • Light microscopy of multiple lung sections found no asbestos bodies and no mesothelioma.
• The authors' conclusion: The authors speculated that the cardiac surgery may have been a factor in promoting the patient's diffuse pleural thickening. They concluded that several factors may have contributed.
• Limitations the authors state:
  • Details of the radiation dose and irradiation site were not available.
  • The authors said a contribution from the earlier irradiation could not be ruled out.
  • No pleural biopsy was performed during life, because of a bleeding tendency from anticoagulant therapy.
  • The patient may already have had ventilation impairment before the cardiac surgery, and the dates of the imaging were not provided in the images.

Topics

Medical terms in this study, explained in our Lexicon: Diffuse Pleural Thickening, Dyspnea, Bilateral, Pleural Effusion, Autopsy, Pleural Thickening, Asbestos Body Formation, Mesothelioma.

Related studies

• Causes of pulmonary impairment in asbestos-exposed individuals with diffuse pleural thickening — S.T. Kee, G. Gamsu, et al. (1996)
• Ventilatory insufficiency due to asbestos-related diffuse pleural fibrosis successfully treated with noninvasive home mechanical ventilation — X. Muñoz, A. Roger, et al. (2001)
• "Not your grandfather's pleural disease": rapid progression, ventilatory impairment, and chronic pleuritic pain from Libby vermiculite/amphibole — A. Miller (2014)
• Fibrinogen concentrate as first-line therapy in children undergoing cardiac surgery: Promising perspectives — D. Faraoni (2015)
• Asbestosis, pleural plaques and diffuse pleural thickening: three distinct benign responses to asbestos exposure — P.A. Gevenois, V. de Maertelaer, et al. (1998)
• Diffuse pleural thickening in asbestos workers: disability and lung function abnormalities — C.R. McGavin, G. Sheers (1984)

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