Nonoccupational diffuse pulmonary fibrosis. A report of a case in an asbestos worker

Our plain-English summary of Nonoccupational diffuse pulmonary fibrosis. A report of a case in an asbestos worker, by P. Cartier, P. Gross (Archives of Environmental Health, 1962).

The study

• Authors: P. Cartier, P. Gross
• Journal: Archives of Environmental Health
• Published: 1962;4:73-80
• Type of article: Case report
• Cited by: 2 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. 001579).

In plain English

This was a case report of one man, a 69-year-old French-Canadian who had worked in an open-pit chrysotile asbestos mine for nearly 40 years. The article described his asbestos dust exposure in most of his jobs as exceedingly low, negligible or insignificant. He had been treated for chronic bronchitis since 1928. Chest X-rays showed no abnormality until 1953, after which lung markings and opacities increased. In February 1960 he developed breathlessness and cyanosis. About eight months later he was admitted to hospital, and he died 11 days after that. A limited postmortem, using thin slices of lung and heart from the embalmed body, showed diffuse thickening of the lung's alveolar walls and thickened pleura. Not a single asbestos body was found despite diligent search, so the authors excluded asbestosis. They likened the case to Hamman-Rich disease. They proposed that a chronic interstitial pneumonitis of unknown cause had begun about 32 years before death, and that a superimposed patchy bronchopneumonia was the immediate cause of death. The authors concluded the case illustrated the hazard of diagnosing pneumoconiosis on purely presumptive evidence.

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, with limited postmortem examination)
• Who was studied: One 69-year-old French-Canadian man who worked in an open-pit chrysotile asbestos mine in Quebec, Canada, and died in 1960
• Exposure: Work in an open-pit chrysotile asbestos mine for nearly 40 years (the summary says 38 years). His jobs were box loader in 1919, with dust described as exceedingly low; drill operator from 1922 to 1944, with more serpentine rock dust than asbestos dust and asbestos exposure considered insignificant; crude picker from 1944 to 1949, with exposure considered negligible; garage mechanic from 1949 to 1950, with no dust; and belt picker from 1950 to 1960, with exposure deemed insignificant. His occupational history before 1919 is not known.
• Main results:
  • Chest X-rays showed no abnormality up to 1953. From then on, linear markings became exaggerated and reticulonodular opacities appeared over both lung fields, increasing in severity.
  • From February 1960 he had respiratory insufficiency with breathlessness on moderate exertion and cyanosis. About 8 months later he was admitted to hospital, was given oxygen, and died 11 days later.
  • The senior author had been reluctant during life to diagnose asbestosis. The reasons given were that the patient's asbestos-dust exposure seemed insignificant relative to the severity of the fibrosis, and that the rapid evolution of signs differed from the slow progression seen in asbestosis cases.
  • Microscopy of the lungs showed diffuse, uniform thickening of the alveolar walls by proliferated alveolar cells and associated stroma. There was also inflammatory cell infiltration, and more extensive collagen fibrosis beneath the pleura and in the hilar regions.
  • The visceral pleura was everywhere covered by thickened, adherent parietal pleura.
  • No asbestos bodies were found in any of the lung sections despite diligent search.
• The authors' conclusion: The authors concluded that asbestosis could be excluded because no asbestos bodies were found. They judged the case to be a nonoccupational diffuse chronic interstitial pulmonary fibrosis that began about 32 years before death, with a superimposed patchy bronchopneumonia as the immediate cause of death. They also concluded that the case illustrates the hazard of clinically diagnosing pneumoconiosis on purely presumptive evidence. In their view, a sound diagnosis requires knowledge of significant exposure to dust of respirable particle size and of the clinical and radiological course of the disease.
• Limitations the authors state:
  • The authors reported that the postmortem examination was limited to a thin slice from each lung and from the heart, taken from the embalmed body.
  • The authors noted that not all portions of the lungs were well fixed.
  • The patient's occupational history before 1919 was not known.

Topics

Medical terms in this study, explained in our Lexicon: Pulmonary Fibrosis.

Related studies

• Interaction of asbestos, age, and cigarette smoking in producing radiographic evidence of diffuse pulmonary fibrosis — K.H. Kilburn, R. Lilis, et al. (1986)
• Pulmonary fibrosis in asbestos insulation workers with lung cancer: a radiological and histopathological evaluation — H.M. Kipen, R. Lilis, et al. (1987)
• 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)
• Idiopathic pulmonary fibrosis in asbestos-exposed workers — E.A. Gaensler, P.J. Jederlinic, et al. (1991)
• Frequency of HLA antigen in asbestos workers with and without pulmonary fibrosis — C.C. Evans, H.C. Lewinsöhn, et al. (1977)
• Pulmonary fibrosis, carcinoma, and ferruginous body counts in amosite asbestos workers. A study of six cases — V.L. Roggli, S.D. Greenberg, et al. (1980)

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