Paraplegia due to massive asbestos-related pleural and mediastinal fibrosis

Our plain-English summary of Paraplegia due to massive asbestos-related pleural and mediastinal fibrosis, by C.J. O'Brien, A.J. Franks (Histopathology, 1987).

The study

• Authors: C.J. O'Brien, A.J. Franks
• Journal: Histopathology
• Published: 1987;11(5):541-8
• 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. 000990).

Abstract

A case of massive pleural and mediastinal fibrosis related to occupational exposure to asbestos is presented. The terminal illness was marked by the acute onset of paraplegia. Autopsy revealed occlusive lesions of upper intercostal arteries within sheets of dense fibrous tissue and an ischaemic myelopathy. The presence of vascular lesions suggests a relationship with idiopathic mediastinal fibrosis.

In plain English

This case report from the University of Leeds, UK, described one man, a boiler maintenance engineer with heavy but intermittent exposure to asbestos lagging between 1951 and 1974. The article did not name a fiber type. He presented in November 1976, aged 49, with cough, breathlessness and left-sided chest pain. Surgery found grossly thickened pleura but no cancer, and the pleura was removed. Microscopy showed inflammation and numerous asbestos bodies in the lung, without conclusive evidence of asbestosis or mesothelioma. In December 1983 he was admitted with paralysis of both legs (paraplegia) and died. At autopsy, dense fibrous tissue encased both lungs, the thoracic aorta and the oesophagus. The upper intercostal arteries were blocked, and the spinal cord showed infarction. The authors judged mesothelioma untenable. They suggested that the cord damage was triggered by reduced blood flow in an already severely compromised circulation. They said they felt the tissue findings represented an unusually florid immune reaction to asbestos. In their view this resembled idiopathic mediastinal fibrosis.

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, clinical history plus surgical and autopsy pathology)
• Who was studied: One man, a boiler maintenance engineer, who presented in November 1976 at age 49 and died after admission in December 1983; reported from the Department of Pathology, University of Leeds, UK
• Exposure: Heavy but intermittent occupational exposure to asbestos lagging between 1951 and 1974; no fiber type is named
• Main results:
  • At exploratory left thoracotomy (1976 to 1977) the pleura was grossly thickened, but the lung was well aerated and no carcinoma was found; total pleurectomy and decortication were performed
  • The pleurectomy specimen showed dense fibrosis with chronic inflammation and inflamed, narrowed small arteries, and numerous asbestos bodies in the adjacent lung air spaces, but no conclusive evidence of asbestosis or mesothelioma
  • At the final admission in December 1983 the patient had a flaccid paraplegia with a sensory level at T3-4; he later aspirated food, had a cardio-respiratory arrest and died
  • At autopsy, both lungs, the thoracic aorta and the oesophagus were encased in hard white tissue mostly 6-7 mm thick (up to 17 mm behind the sternum), and the upper intercostal arteries could not be perfused
  • Microscopy confirmed spinal cord infarction from T2 down to L1, affecting the anterior two-thirds of the cord; the anterior spinal arteries appeared normal
  • The lung showed no diffuse interstitial fibrosis but numerous asbestos bodies; no asbestos bodies were seen in the thickened pleura
  • The authors considered mesothelioma untenable: no area resembling a tumour was found, the patient survived 7 years after diagnosis of extensive pleural disease, and there was no spread beyond the chest at autopsy
• The authors' conclusion: The authors suggested that the spinal cord infarction was precipitated by reduced blood flow in an already severely compromised cord circulation. They called the occupational exposure and the lung asbestos bodies strong circumstantial evidence that asbestos played an underlying role. They felt the histology represented an unusually florid immunological reaction to asbestos. They added that its similarity to idiopathic mediastinal and retroperitoneal fibrosis suggests that similar immune mechanisms may operate in those conditions.
• Limitations the authors state:
  • The authors described the evidence for asbestos as the cause in this case as circumstantial
  • The authors acknowledged that the unusual inflammatory and vascular findings might simply reflect the stage of disease at the time of examination

Topics

Medical terms in this study, explained in our Lexicon: Fibrosis, Occupational Exposure, Autopsy, Idiopathic.

Related studies

• Pleural irregularities and mediastinal pleural involvement in early stages of malignant pleural mesothelioma and benign asbestos pleural effusion — K. Kato, K. Gemba, et al. (2016)
• Spinal cord ischemia resulting in paraplegia following extrapleural pneumonectomy — K. Ural, K. Jakob, et al. (2014)
• Retrosternal and pleural "bridging" fibrosis mimicking malignancy in a patient exposed to asbestos — M.P. Debray, S. Marchand-Adam, et al. (2010)
• Minimally invasive, ionizing-free, and ultrasound-guided technique to biopsy anterior mediastinal masses: first 60 cases — B. Lorenzati, R. Cristofori, et al. (2018)
• Mediastinal and Pleural MR Imaging in Daily Practice — A.M. Priola, A. Veltri, et al. (2018)
• Length-dependent retention of carbon nanotubes in the pleural space of mice initiates sustained inflammation and progressive fibrosis on the parietal pleura — F.A. Murphy, C.A. Poland, et al. (2011)

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