Radiological features of asbestos-related visceral pleural changes

Our plain-English summary of Radiological features of asbestos-related visceral pleural changes, by A. Solomon (American Journal of Industrial Medicine, 1991).

The study

• Author: A. Solomon
• Journal: American Journal of Industrial Medicine
• Published: 1991;19(3):339-55
• Type of article: Review
• Cited by: 11 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. 004104).

Abstract

The radiological manifestations of asbestos-related visceral pleural changes are described. Generally, visceral pleural reactions follow the mesothelial cells response to various injurious substances, including asbestos, and even saline. The changes are nonspecific. They may occur subsequent to pleural reactions associated with many conditions, which include tuberculosis, viral pleurisy, malignancy and lymphoma, lupus, or rheumatoid-induced effusions, cardiac failure, and pulmonary embolism, among other etiologies. The failure to absorb the fibrinous exudate on the visceral pleural surface can lead to the development of diffuse fibrosis of the serosal surface, interlobar pleural thickening, localized pleural filaments (strands), subpleural wedge, and lenticular-shaped masses, and could be the forerunner of lobular atelectasis (pseudotumor) formation. Some of the features are recognized on posteroanterior chest radiographs and the counterparts corroborated with the use of routine and high-resolution computed tomography studies.

In plain English

This article was a narrative review by a radiologist at Tel-Aviv Medical Center. It described how asbestos-related changes in the visceral pleura (the lining on the lung surface) appear on plain chest radiographs and on routine and high-resolution CT. It was illustrated with images from people with known asbestos exposure. It reported no new study group or rates. The author explained that the visceral pleura is tied into the lung by septa. This lets visceral changes be told apart from parietal ones. Visceral-only thickening can be recognized in the interlobar fissures. The author described pleural strands or tags, sometimes crossing in a "crows' feet" pattern, that penetrate the lung and can be shown on CT. The author described subpleural wedge-shaped and lenticular opacities and rounded atelectasis (pseudotumor). The author argued that calling these CT opacities rounded atelectasis could be erroneous, since on plain radiographs they often show as only simple pleural strands. The author added that the diagnosis of lobular atelectasis should meet all its criteria. The changes were described as nonspecific. The author concluded that knowledge of visceral pleural anatomy and pathology is basic to interpreting radiographs and CT.

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: Narrative review of radiological and pathological literature, illustrated with example radiographs and CT images
• Who was studied: No study population. The review was illustrated with individual images from persons with known asbestos exposure; no number of cases was given.
• Exposure: Asbestos in general (no specific fiber type analyzed). The author noted that the pleural reaction also follows other injurious agents.
• Main results:
  • The author described the interlobar fissures as the place where pleural thickening or plaque formation is visceral only. Elsewhere on the lung surface, visceral changes on their own are difficult to identify.
  • The author described pleural strands that are pronounced enough to be seen on plain chest radiographs. More discrete strands may be missed on routine radiographs but can be shown on routine and high-resolution CT.
  • The author described these strands or tags as penetrating the lung, representing interlobular septal thickening and fibrotic reaction.
  • The author questioned the suggestion of Lynch and colleagues that rounded atelectasis is frequent. The author argued that the plain-radiograph counterpart of the subpleural wedge-shaped and lenticular opacities is often no more than simple isolated pleural strands.
  • The author described a fully formed pseudotumor (rounded atelectasis) as a rounded subpleural opacity of 2 to 7 cm on PA chest radiographs, with pleural thickening always present. Demonstrating distorted, curving bronchi and vessels was described as mandatory for the diagnosis.
  • The author described the changes as nonspecific. When a pleural effusion is the only finding, many other causes must be considered.
• The authors' conclusion: The author concluded that knowing the anatomy of the visceral pleura and the pathological changes after asbestos exposure is basic to interpreting plain chest radiographs and CT of the lung.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Mesothelial Cells, Pleurisy, Exudate, Fibrosis, Serosal Surface, Pleural Thickening, Atelectasis, Chest X-Ray.

Related studies

• Radiological features of diffuse mesothelioma — A. Solomon (1970)
• Radiological changes in asbestos cement workers — K. Jakobsson, U. Strömberg, et al. (1995)
• Lung function, radiological changes and exposure: analysis of ATSDR data from Libby, MT, USA — D. Weill, G. Dhillon, et al. (2011)
• Genes involved in innate immunity associated with asbestos-related fibrotic changes — M.K. Kukkonen, T. Vehmas, et al. (2014)
• Calcified interlobar pleural plaques: visceral pleural involvement due to asbestos — E.N. Sargent, J.S. Felton, et al. (1981)
• High-resolution computed tomography features of asbestosis versus fibrotic hypersensitivity pneumonitis: an observational study — R. Ma, S. Li, et al. (2022)

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