Pleural Asbestosis

Our plain-English summary of Pleural Asbestosis, by H.B. Eisenstadt (1962).

The study

• Author: H.B. Eisenstadt
• Published: American Practitioner 13(9):573-578, September (1962)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 001580. The article is still under copyright, so we describe it here rather than post it.

In plain English

This article, by a physician at a medical clinic in Port Arthur, Texas, described three men in whom, in the author's account, asbestosis presented as an idiopathic pleural disease (a disease of the lining around the lungs with no obvious cause), without prominent clinical or x-ray signs of disease in the lung tissue itself. The first, a 54-year-old insulator, had pleurisy on one side and later on the other. After surgery to remove the thickened lining, his symptoms disappeared, and a lung biopsy showed asbestos bodies. The second, a 57-year-old refinery foreman, developed air and fluid around the left lung that slowly turned into thick scar tissue. A later rib biopsy showed pleural mesothelioma. No lung biopsy was taken, which the author said would have been needed to confirm asbestosis. The third, a 58-year-old oil refinery foreman who had worked with asbestos insulation, had calcifications of the lung lining after an earlier pleurisy. Biopsy and autopsy later established primary pleural mesothelioma associated with pulmonary asbestosis. The author concluded that only a lung biopsy showing asbestos bodies in the lung tissue can clinch the diagnosis.

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 of three patients (case series)
• Who was studied: Three men described by a physician at a medical clinic in Port Arthur, Texas: a 54-year-old white male insulator (pleurisy in 1960 and 1961), a 57-year-old refinery foreman, and a 58-year-old oil refinery foreman (seen in January 1959)
• Exposure: Occupational asbestos exposure over many years: work as an insulator (Case 1), asbestos work (Case 2), and work with asbestos insulation (Case 3). Fiber types were not named.
• Main results:
  • Case 1: after surgery (decortication) and a lung biopsy, all symptoms disappeared.
  • Case 1: the lung biopsy showed thickened alveolar walls with macrophages and asbestos bodies.
  • Case 1: the sedimentation rate was 83 mm per hour (Westergren).
  • Case 1: the Latex agglutination test was positive in a 1:80 dilution.
  • Case 1: pulmonary function testing after decortication gave normal results.
  • Case 2: a left-sided pneumothorax with effusion was gradually replaced by a fibrothorax over several months.
  • Case 2: after rib destruction was found, a biopsy of the region showed pleural mesothelioma.
  • Case 3: after an earlier episode of bilateral pleurisy, bilateral pleural calcifications were visible on x-rays.
  • Case 3: biopsy and autopsy established primary pleural mesothelioma associated with pulmonary asbestosis.
  • None of the three patients showed prominent clinical or x-ray findings of disease in the lung tissue.
• The authors' conclusion: The author concluded that only a lung biopsy demonstrating asbestos bodies in the lung tissue can clinch the diagnosis, particularly when the disease presents primarily as an idiopathic pleurisy.
• Limitations the authors state:
  • In Case 2 no lung biopsy was obtained, and the author states one would have been necessary to confirm the diagnosis.
  • Pulmonary function studies were done only in Case 1, after decortication.

Topics

Medical terms in this study, explained in our Lexicon: Idiopathic, Insulator, Pleurisy, Biopsy, Asbestos Bodies, Pleural Mesothelioma, Autopsy, Asbestosis.

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