Radiological features of diffuse mesothelioma

Our plain-English summary of Radiological features of diffuse mesothelioma, by A. Solomon (Environmental Research, 1970).

The study

• Author: A. Solomon
• Journal: Environmental Research
• Published: 1970;3(4):330-8
• Cited by: 26 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. 001414).

Summary of the article

This article described the chest X-ray appearances of diffuse pleural mesothelioma in a retrospective radiological study of 23 cases whose pathology had been confirmed by the Asbestos Tumour Reference Panel of South Africa. The author worked at the Pneumoconiosis Research Unit in Johannesburg and Baragwanath Hospital, Transvaal. Many patients had worked in asbestos mining. Some had not handled asbestos but had lived in areas where it was mined and milled. Nine had been born in, and lived for many years in, "calcific areas". The youngest patient was 21. Pleural effusion was the main X-ray feature in 14 cases. Six cases showed a lobular pleural tumour with no obvious effusion. Lobular pleural masses were seen in 15 patients, and in six of these, aspiration of fluid with an induced pneumothorax was needed to show the tumour. Hilar masses on the tumour side were present in six cases and extrathoracic soft-tissue masses in three. One patient presented with a hydropneumothorax. Parenchymal lung changes were seen in five cases, non-calcified pleural changes on the opposite side in seven, and pleural calcification in two. Eighteen cases had no significant radiological signs of parenchymal fibrosis. The author recommended introducing a small amount of air into the pleural cavity, and taking decubitus views, when only an effusion is seen. He considered a hilar mass in an asbestos-exposed person ominous once tuberculosis is excluded.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article reported a retrospective review of chest X-rays from 23 patients in South Africa with pleural mesothelioma, whose diagnosis had been confirmed by the Asbestos Tumour Reference Panel of South Africa. Many patients had worked in asbestos mining. Some had not handled asbestos but had lived where it was mined and milled. Fourteen patients showed a pleural effusion (fluid around the lung) as the main X-ray feature. Fifteen had lobular (lumpy) pleural masses. Six had hilar masses on the same side as the tumour, three had soft-tissue masses outside the chest, and one had a hydropneumothorax (air and fluid in the chest). Lung fibrosis was seen in five cases and was only moderate. Eighteen showed no significant X-ray signs of lung fibrosis. Pleural calcification appeared in two cases. The author cautioned that detecting calcification depends on X-ray technique, so no real inference could be drawn about its infrequency. The author concluded that diffuse pleural mesothelioma looks different on X-ray from cancers that spread to the pleura from elsewhere.

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: retrospective radiological case series (review of chest X-rays)
• Who was studied: 23 patients in South Africa with pleural mesothelioma whose pathology was confirmed by the Asbestos Tumour Reference Panel of South Africa. The article says males predominated, but its table of sex distribution did not survive in the text. Years of diagnosis are not stated.
• Exposure: Asbestos exposure. Many patients worked in asbestos mining. Some had not handled asbestos but lived in areas of asbestos mining and milling ("calcific areas"). Fiber types for these patients are not given in the surviving text.
• Main results:
  • 14 of the 23 patients presented with pleural effusion as the main X-ray feature. Of these, six effusions were right-sided and seven left-sided. One patient with a right pleural mesothelioma had effusions on both sides.
  • 15 patients had lobular pleural masses on X-ray. In 6 cases a lobular pleural tumour was seen with no X-ray sign of an effusion.
  • Hilar masses were seen in 6 cases, on the same side as the pleural tumour.
  • 3 patients had soft-tissue masses outside the chest. Each had an effusion on the same side.
  • One patient presented with a hydropneumothorax. The pleural tumour was easily visible in this case.
  • Lung (parenchymal) changes were seen in 5 cases. They were only moderate, with no progressive massive fibrosis. 18 cases had no significant X-ray changes suggesting parenchymal fibrosis.
  • Non-calcified pleural changes appeared on the side opposite the tumour in 7 cases.
  • Pleural calcification was seen in only 2 cases: a small calcified plaque in one female patient and extensive bilateral sheets of calcification in one male patient. Five patients older than 60 who were born in "calcific areas" showed no calcification.
• The authors' conclusion: The authors concluded that diffuse pleural mesothelioma behaves differently on X-ray from the more common secondary (spread) pleural cancers. Lobular encasement of the lung, hilar changes, pleural signs of asbestosis, lung fibrosis and soft-tissue masses should be looked for as supportive evidence to aid the pathologist.
• Limitations the authors state:
  • Detection of pleural calcification varies with X-ray technique, so no real inference can be drawn about how infrequent calcification was in this series.
  • The high proportion of males may reflect selection, since many of these patients worked in asbestos mining.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Chest X-Ray, Pleural Mesothelioma, Pathology, Pneumoconiosis, Transvaal, Pleural Effusion, Pneumothorax.

Related studies

• Radiology of asbestosis — A. Solomon (1970)
• Radiological features of asbestos-related visceral pleural changes — A. Solomon (1991)
• A retrospective study on radiological findings of diffuse pleural thickening with benign asbestos pleural effusion in Japanese cases — T. Kishimoto, K. Kato, et al. (2022)
• Development, radiological zone patterns, and importance of diffuse pleural thickening in relation to occupational exposure to asbestos — H. Bohlig, A. Calavrezos (1987)
• Lung function, radiological changes and exposure: analysis of ATSDR data from Libby, MT, USA — D. Weill, G. Dhillon, et al. (2011)
• Radiological survey of past and present vermiculite miners exposed to tremolite — J.C. McDonald, P. Sebastien, et al. (1986)

Browse more research in Environmental Research, or return to medical research.