Massive bilateral upper lobe fibrosis secondary to asbestos exposure

Our plain-English summary of Massive bilateral upper lobe fibrosis secondary to asbestos exposure, by R.A. Green, D.G. Dimcheff (Chest, 1974).

The study

• Authors: R.A. Green, D.G. Dimcheff
• Journal: Chest
• Published: 1974;65(1):52-5
• Cited by: 13 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. 001269).

Abstract

Three patients with massive bilateral upper lobe fibrosis due to asbestos exposure are presented. This pattern of involvement is unusual in asbestosis. Asbestosis should be considered as a possible cause of such roentgenographic changes, especially if the etiology of the upper lobe fibrosis is otherwise unclear.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This article reported three cases: men treated at Veterans Administration hospitals in the Bronx, New York, and Ann Arbor, Michigan, who had massive scarring (fibrosis) in the upper lobes of both lungs. The authors called the cases unusual because the scarring was reversed from its usual place in asbestosis. The first man, a restaurant counterman, never had an adequate exposure history taken. His autopsy found pleural plaques, ferruginous bodies, a rare crystal compatible with talc, and peritoneal mesothelioma. The second, a farmer who had handsawed asbestos blocks in an insulation factory 30 years earlier, died of metastatic rectal cancer. The third had worked in railroad cars being insulated with asbestos in 1925-1928 but at first denied exposure. No ferruginous bodies were seen on his routine slides, but asbestos was shown by electronic ashing of lung tissue. The authors found no other disease explaining the upper lobe scarring, while allowing that one may have gone unrecognized. They concluded this was more likely another pattern of asbestos-related disease.

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 (case reports of three patients, with clinical and autopsy findings)
• Who was studied: Three white men: a 65-year-old restaurant counterman admitted to the Veterans Administration Hospital, Bronx, NY, in 1955; a 61-year-old farmer admitted to the Ann Arbor Veterans Administration Hospital in 1965; and a 67-year-old farmer admitted to the Ann Arbor Veterans Administration Hospital in 1967
• Exposure: Asbestos (fiber type not named). Case 2 worked well over one year in an insulation factory about 30 years earlier, handsawing blocks of asbestos with intense dust exposure. Case 3 worked as a carpenter in railroad cars being insulated with asbestos from 1925 to 1928, with intense dust exposure in closed spaces. No adequate exposure history was taken for Case 1, whose lungs also showed a rare crystal compatible with talc.
• Main results:
  • The authors described the cases as unusual because the distribution of fibrosis was reversed, with massive fibrosis of the upper lobes.
  • Case 1 (restaurant counterman): at autopsy, the upper lobes were shrunken and fibrotic. There was extensive bilateral pleural thickening with pleural plaques and calcifications, ferruginous bodies, and a rare birefringent crystal compatible with talc. Peritoneal mesothelioma explained his abdominal disease.
  • Case 2 (farmer, former insulation factory worker): autopsy showed massive bilateral upper lobe fibrosis, mild interstitial fibrosis of the remaining lung, extensive pleural fibrosis and calcification, and rare ferruginous bodies. He died of metastatic adenocarcinoma of the rectum.
  • Case 3 (farmer, former railroad car carpenter): he initially denied asbestos exposure and recalled it only after detailed questioning. No ferruginous bodies were seen on routine sections, but asbestos was demonstrated by electronic ashing of lung specimens. No neoplasm was found despite a sputum smear positive for carcinoma cells.
  • Clinical and postmortem examinations did not identify a complicating disease to explain the massive upper lobe involvement.
• The authors' conclusion: The authors concluded that asbestos was the most likely cause, and that the upper lobe involvement more likely represented another pattern of asbestos-associated disease. They stated that this X-ray pattern should prompt physicians to consider asbestos as a possible cause of bilateral upper lobe massive fibrosis.
• Limitations the authors state:
  • The authors acknowledged that the patients may have had an unrecognized complicating upper lobe disease.
  • For Case 1, an adequate occupational exposure history was never taken.
  • In Case 1, the presence of talc crystals suggested that talc may have influenced the fibrotic response to asbestos.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Bilateral, Fibrosis, Asbestos Exposure, Etiology.

Related studies

• Pleural and parenchymal fibrosis mainly affecting the upper lung lobes in persons exposed to asbestos — G. Hillerdal (1990)
• Massive pulmonary fibrosis from the inhalation of talc — A.C. Hunt (1956)
• Some investigations into the nature and cause of massive fibrosis (MF) in the lungs of South African gold, coal, and asbestos mine workers — M.C. Leibowitz, B. Goldstein (1987)
• Asbestos exposure and tuberculous pleurisy as developmental causes of progressive unilateral upper-lung field pulmonary fibrosis radiologically consistent with pleuroparenchymal fibroelastosis — A. Sekine, E. Hagiwara, et al. (2021)
• Asbestosis: interstitial pulmonary fibrosis and pleural fibrosis in a cohort of asbestos insulation workers: influence of cigarette smoking — R. Lilis, I.J. Selikoff, et al. (1986)
• Relation of spirometric function to radiographic interstitial fibrosis in two large workforces exposed to asbestos: an evaluation of the ILO profusion score — A. Miller, R. Lilis, et al. (1996)

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