Pulmonary encasement - a sign of advanced malignant diffuse mesothelioma

Our plain-English summary of Pulmonary encasement - a sign of advanced malignant diffuse mesothelioma, by I.M. Kendall-Smith (Australasian Radiology, 1979).

The study

• Author: I.M. Kendall-Smith
• Journal: Australasian Radiology
• Published: 1979;23(1):24-9
• Type of article: Case report
• Read it: PubMed · Publisher

In plain English

This article, by a radiologist recently of Otago University and Dunedin Public Hospital, New Zealand (now Brisbane), described three patients with malignant diffuse pleural mesothelioma. Two were 69-year-old men. One was a company director with no known asbestos exposure who had smoked for 40 years. The other had worked for many years as a machinist in railway workshops where asbestos material was widely used. The third patient was a 65-year-old woman with no known asbestos exposure. In each case, chest X-rays showed a thick, nodular rind of tumour progressively encasing the lung, and pleural biopsies were reported as undifferentiated carcinoma. All three patients died within 6 months. All three had rib and chest wall involvement, and two had pericardial involvement. No asbestos bodies were found at autopsy in the two men; none are reported for the woman. The author noted that a large, usually bloody effusion could hide the pleural thickening, which might show clearly only after a pneumothorax induced during pleurocentesis or biopsy. The author concluded that a radiologist's high index of suspicion could offer the chance of early 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 series (three case reports)
• Who was studied: Three patients: a 69-year-old Caucasian man (company director), a 69-year-old Caucasian man (former railway workshop machinist), and a 65-year-old Caucasian woman. The author is listed as recently a lecturer and staff radiologist at Otago University and Dunedin Public Hospital, New Zealand, with a present address in Brisbane, Australia. Dates of the cases are not given.
• Exposure: Only Case 2 had a known asbestos-related job: many years as a machinist in railway workshops where asbestos material had been in widespread use. No fiber type was named. Cases 1 and 3 had no known asbestos exposure. Case 1 had smoked 4 ounces of tobacco weekly over 40 years.
• Main results:
  • All three patients died within 6 months, after what the author called a relatively benign presentation.
  • All three cases had rib and chest wall involvement.
  • The pericardium was involved in two of the three cases.
  • No asbestos bodies were found at autopsy in Case 1 or Case 2. The article does not report on asbestos bodies for Case 3.
  • Pleural biopsies were reported as undifferentiated carcinoma: probably large cell type in Case 1, undifferentiated carcinoma in Case 2, and small cell undifferentiated carcinoma in Case 3.
  • Pleural effusion was frequent and usually bloody. Its size could mask the pleural thickening until after pleurocentesis or pleural biopsy.
  • The author noted that the encasing rind may become obvious only after a pneumothorax is incidentally induced.
• The authors' conclusion: The author concluded that each case showed the characteristic progressive diffuse encasement of the lung by a thickened nodular pleural tumour, like a rind. The author also concluded that diagnosis is often difficult and that a radiologist keeping a high index of suspicion can offer the chance of an early diagnosis.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma.

Related studies

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• Signs of asbestosis and impaired pulmonary function in women who worked in shipyards — K.H. Kilburn, R. Warshaw, et al. (1985)
• Interaction of asbestos, age, and cigarette smoking in producing radiographic evidence of diffuse pulmonary fibrosis — K.H. Kilburn, R. Lilis, et al. (1986)
• Open lung biopsy in patients with diffuse pulmonary shadowing — G.E. Venn, P.H. Kay, et al. (1985)
• Combined systemic chemoimmunotherapy in advanced diffuse malignant mesothelioma. Report of a phase I-II study of weekly cisplatin/interferon alfa-2a — P. Soulié, P. Ruffié, et al. (1996)
• Asbestos disease in sheet metal workers: II. Radiologic signs of asbestosis among active workers — D. Michaels, S. Zoloth, et al. (1987)

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