Migrating pleural plaque in a patient with asbestos induced pleural disease: a case report

Our plain-English summary of Migrating pleural plaque in a patient with asbestos induced pleural disease: a case report, by C. Eisenhawer, M.K. Felten, T. Hager, et al (Journal of Occupational Medicine and Toxicology, 2017).

The study

• Authors: C. Eisenhawer, M.K. Felten, T. Hager, M. Gronostayskiy, P. Bruners, A. Tannapfel, T. Kraus
• Journal: Journal of Occupational Medicine and Toxicology
• Published: 2017;12:25
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Health surveillance of formerly asbestos exposed individuals focus on early detection of asbestos related diseases, such as lung fibrosis (asbestosis), pleural plaques, mesothelioma and lung cancer in particular. One main concern is the early and clear identification of lesions with a high risk of malignant changes and their undelayed clinical work-up. False positive results may lead to unnecessary and often painful diagnostic interventions, which create high costs when applied to a large cohort and also may discredit the whole program. We describe an unusual presentation of a common lesion among asbestos exposed individuals, which has to our knowledge never been described before. Being aware of this pathological pathway may prevent inadequate clinical decisions with disadvantages for the patient. Underlying implications regarding health surveillance and the reading of CT-scans of the thorax are important for the management of formerly asbestos exposed individuals.

Case Presentation: During follow-up of an asbestos exposed 72 year old former power plant worker with known pleural changes, a nodule located next to the left costophrenic angle was newly discovered on CT-scan. As the previous scan 1 year before did not show any changes in that area, a fast growing tumour was suspected and an immediate biopsy performed. The tissue showed the characteristics of a pleural plaque with no signs of malignancy. After carefully reviewing all previous radiographs a rounded opacity attached to the mediastinal pleura close to the oesophagus and slightly cranial to the position of the removed nodule could be discerned. That nodule had increased in size over several years and was no longer visible on the latest scan. It appeared that the originally slow growing plaque had migrated to the costophrenic angle some time before it was discovered in the latest scan thus imposing as a fast growing tumour.

Conclusions: We concluded that asbestos related pleural plaques can under special circumstances get separated from the pleura and migrate to another position in the pleural cavity. The case provides new insights in the development and properties of pleural lesions and may offer new options for the management of formerly asbestos exposed patients.

In plain English

This case report described a 72-year-old former power plant welder and fitter in a German surveillance program for formerly highly asbestos-exposed employees with non-malignant asbestos-related lung or pleural disease. He had known bilateral, partly calcified pleural plaques. The article did not give his fiber type or exposure amount. In 2014, a routine CT scan showed a new, centrally calcified 21 × 13 mm nodule in the left costophrenic angle (the lower corner of the chest). It had not been seen there a year earlier. A fast-growing tumour was suspected, and the nodule was surgically removed. Tissue analysis found a hyaline pleural plaque with no signs of asbestos bodies or malignancy. A second laboratory confirmed this, noting a stalk-like attachment. CT scans back to 2005 showed a nodule near the oesophagus that grew slowly until 2014, when it appeared lower down. Weeks before the 2014 examination, the patient made a strenuous mountain hike, followed by severe chest pain. The authors proposed that this exertion started the plaque's separation. They concluded that pleural plaques can, under special circumstances, detach and migrate within the pleural cavity.

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 (one patient)
• Who was studied: One 72-year-old former power plant worker (welder, fitter) with known bilateral partially calcified pleural plaques. He was examined in 2014 in a surveillance program run from RWTH Aachen University, Germany, for formerly highly asbestos-exposed employees with a diagnosis of non-malignant asbestos-related disease of lung or pleura. His CT scans were reviewed back to 2005.
• Exposure: Former occupational asbestos exposure as a power plant welder and fitter. The fiber type and the patient's cumulative dose are not reported. He also smoked about 10 cigarettes per day in 1959 to 1960.
• Main results:
  • A CT scan in 2014 showed a newly appeared 21 × 13 mm nodule with central calcification in the left costophrenic angle. It was not present there on the 2013 scan.
  • After surgical removal, the tissue was described as a hyaline pleural plaque with central calcification and no signs of asbestos bodies or malignancy.
  • A second pathology laboratory confirmed a typical asbestos-associated pleural plaque, with a pedunculated (stalk-like) attachment to the pleura.
  • Review of CT scans going back to 2005 showed a rounded calcified opacity attached to the mediastinal pleura near the oesophagus. It slowly grew until 2014, when it appeared lower down in the costophrenic sinus. The authors described this as presumably the same nodule.
  • The patient made a strenuous mountain hike a few weeks before the 2014 examination. About 2 weeks after returning, he had massive chest pain with shortness of breath at rest lasting several hours.
  • The authors proposed that the physical exertion of the mountain hike started the separation of the plaque.
  • One year after surgery, lung function testing showed normal results for FEV1 and VC max.
• The authors' conclusion: The authors concluded that asbestos-related pleural plaques can, under special circumstances, separate from the pleura and migrate to another position in the pleural cavity. In their view, the possibility of migrating plaques mimicking fast-growing tumours should be considered, particularly in patients with known asbestos-related pleural changes.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Plaques, Fibrosis, Mesothelioma, Lung Cancer, Thorax, Costophrenic angle, Biopsy, Pleura.

Related studies

• Roentgenogram of the month. Migrating lung tumor — R.H. Hayward (1974)
• Asbestos-related pleural diseases: dimensional criteria are not appropriate to differentiate diffuse pleural thickening from pleural plaques — J. Ameille, M. Matrat, et al. (2004)
• Carboxyterminal propeptide of type I procollagen in ELF: elevation in asbestosis, but not in pleural plaque disease — L. Lammi, L. Ryhänen, et al. (1999)
• Yellow Nail Syndrome with Bilateral Pleural Plaques and Diffuse Pleural Thickening: A Mimic of Asbestos Related Disease — A. Dallmann, R.L. Attanoos (2018)
• The role of free radicals in asbestos-induced diseases — D.W. Kamp, P. Graceffa, et al. (1992)
• Multiple roles of oxidants in the pathogenesis of asbestos-induced diseases — A. Shukla, M. Gulumian, et al. (2003)

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