Radiographic change over 11 years in a patient with asbestos-related pleural disease

Our plain-English summary of Radiographic change over 11 years in a patient with asbestos-related pleural disease, by R. Hara, Y. Yano, F. Okabe, et al (Respirology Case Reports, 2020).

The study

• Authors: R. Hara, Y. Yano, F. Okabe, T. Kuge, M. Mori, K. Urasaki
• Journal: Respirology Case Reports
• Published: 2020;8(7):e00642
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Asbestos-related pulmonary conditions such as benign asbestos pleural effusion (BAPE) and diffuse pleural thickening (DPT) can develop after many years of asbestos exposure. These conditions cause progressing constrictive deficit in pulmonary function which may lead to respiratory failure and death. We report the case of a 72-year-old man with asbestos-related BAPE and DPT which developed approximately 40 years after occupational asbestos exposure, leading to chronic respiratory failure and death. We were able to observe his clinical course including computed tomography (CT) scan evaluation over 11 years. In addition to this observation, moderate asbestos body concentration was confirmed in autopsy-derived lung tissue. There are few case reports that showed radiographic course of asbestos-related pulmonary disorder initiated as BAPE, followed by unilateral DPT and later bilateral DPT that was histologically proven with asbestos body. We consider his clinical course is important in managing this disease, especially in early phase.

© 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

In plain English

This was a case report about one man, from doctors at Osaka Toneyama Medical Center in Japan. For about three years around age 30 he had handled serpentine asbestos in research. At 72 he was referred for suspected fluid around the right lung. Seven years earlier, another hospital had found fluid and thickening of the lining on the left side, and the fluid cleared without treatment. At his first visit, CT showed thickening of the lining around both lungs, with calcification on the left. Over the next four years this gradually worsened. After bacterial pneumonia he developed chronic respiratory failure and was started on home oxygen and breathing support. He died on the 94th day of a later hospital stay. At autopsy, both lungs were covered by a hard fibrous membrane. No obvious asbestos body was seen under the microscope. A laboratory count found 1086 asbestos bodies per gram of dry lung tissue, which the authors described as moderate exposure. The authors concluded that his clinical course matters for managing this disease, especially early on.

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 one patient followed over 11 years, including autopsy
• Who was studied: One 72-year-old man referred to Osaka Toneyama Medical Center, Japan, for suspected fluid around the right lung
• Exposure: Handled serpentine asbestos in research for approximately three years around age 30
• Main results:
  • Seven years before referral, the patient had a left pleural effusion with pleural thickening on CT at another hospital. The effusion resolved without treatment.
  • At the first visit, chest CT showed bilateral pleural thickening, with calcification on the left pleura.
  • Over the following four years, pleural thickening and calcification gradually progressed.
  • After recurrent bacterial pneumonia and chronic respiratory failure, the patient died on the 94th day of a hospital admission.
  • At autopsy, both lungs were covered by a white, hard, fibrous membrane. Under the microscope, no obvious asbestos body was detected in the membrane tissue.
  • The asbestos body count in tissue from the right lower lobe was 1086 per gram of dry lung tissue. The authors described this as indicating moderate asbestos exposure.
• The authors' conclusion: The authors concluded that this patient's clinical course is important in managing this disease, especially in its early phase.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos-Related Pleural Disease, Benign Asbestos Pleural Effusion, Diffuse Pleural Thickening, Asbestos Exposure, Asbestos Body Formation, Autopsy, Bilateral.

Related studies

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• Biopersistence of refractory ceramic fiber in human lung tissue and a 20-year follow-up of radiographic pleural changes in workers — J.E. Lockey, V.L. Roggli, et al. (2012)
• Asbestos-related radiographic changes by ILO classification of 10 x 10 cm chest X-rays in a screening of the general population — B. Hilt, G. Hillerdal, et al. (1995)
• High-resolution CT of benign asbestos-related diseases: clinical and radiographic correlation — D.R. Aberle, G. Gamsu, et al. (1988)
• Asbestos-related chest diseases: plain radiographic findings — W.T. Miller, W.B. Gefter, et al. (1992)

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