Rounded atelectasis and its association with asbestos-induced pleural disease

Our plain-English summary of Rounded atelectasis and its association with asbestos-induced pleural disease, by R.A. Mintzer, R.M. Gore, R.L. Vogelzang, et al (Radiology, 1981).

The study

• Authors: R.A. Mintzer, R.M. Gore, R.L. Vogelzang, S. Holz
• Journal: Radiology
• Published: 1981;139(3):567-70
• Cited by: 60 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. 002016).

Abstract

Rounded atelectasis (RA) is an unusual form of peripheral lobar collapse which may present as a juxtapleural mass simulating a pulmonary neoplasm. Seven cases of RA were recently encountered in patients with asbestos-induced pleural disease. Since asbestos exposure is associated with mesothelioma, bronchogenic carcinoma, and other tumors, differentiation of RA from these neoplasms is essential in avoiding unnecessary thoracotomy. The radiographic features of RA are sufficiently characteristic, so that in the presence of chronic pleural thickening due to asbestos exposure, the diagnosis can be made with assurance and further work-up avoided.

In plain English

This article was a case series from Northwestern University McGaw Medical Center in Chicago. Between September 1979 and November 1980, the authors identified 11 cases of rounded atelectasis, a form of partial lung collapse that can look like a tumor on X-rays. The report covered the seven of these patients who had a history of asbestos exposure and asbestos-induced pleural disease. All seven were men aged 48 to 87 (mean 64). The article did not name the type of asbestos fiber. The patients were essentially without symptoms. Their X-rays showed rounded masses 2.5 to 5 cm across (mean 3.7 cm), all at the lung bases beside thickened pleura. Six had a thickened fissure, five showed a 'comet tail' sign, and one had pleural effusion. The first patient had chest surgery (thoracotomy), and the other six were spared it. The authors proposed that asbestos-related pleural thickening and plaques fold the lung to form these masses. They concluded that the X-ray features are distinctive enough to tell rounded atelectasis apart from mesothelioma and lung cancer, avoiding unnecessary thoracotomy.

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 (report of seven patients)
• Who was studied: Seven men aged 48 to 87 years (mean 64), out of 11 rounded atelectasis cases identified at Northwestern University McGaw Medical Center, Chicago, between September 1979 and November 1980
• Exposure: History of asbestos exposure, with asbestos-induced pleural disease. Fiber types, jobs and doses are not given. The patient shown in Figure 1 had been exposed 20 years before admission.
• Main results:
  • The seven patients were essentially without symptoms. X-rays showed rounded masses under the pleura measuring 2.5 to 5 cm, with a mean of 3.7 cm.
  • In all seven patients the lesions were at the lung bases and formed an acute angle with the adjacent pleura, which was thickened.
  • Pleural effusion was seen in one of the seven patients. Thickening of the fissure was seen in six.
  • The 'comet tail' sign was seen in five of the seven patients.
  • Conventional tomography helped document the findings. CT played a confirmatory but not decisive role in three patients.
  • The first patient, studied before the authors knew of rounded atelectasis, underwent thoracotomy. The remaining six were spared the procedure.
  • Only one patient had a significant amount of pleural fluid before rounded atelectasis developed. The authors judged that pleural involvement was apparently related to pleural plaques rather than long-standing effusion.
  • In the first patient, a lung tissue section showed fibrosis, a ferruginous body and a giant-cell histiocyte.
  • The authors proposed that thickening of the fissure seen with asbestos exposure causes partial collapse of the adjacent lower lobe. In their proposal, the collapsed lung becomes fixed to pleural plaques and folds as the pleural disease progresses.
• The authors' conclusion: The authors concluded that, once recognized, the X-ray features of rounded atelectasis are distinctive enough to tell it apart from mesothelioma and bronchogenic carcinoma and to spare patients unnecessary thoracotomy.

Topics

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

Medical terms in this study, explained in our Lexicon: Rounded Atelectasis, Neoplasm, Asbestos Exposure, Mesothelioma, Bronchogenic Carcinoma, Thoracotomy, Pleural Thickening.

Related studies

• The association of asbestos-induced pleural disease and rounded atelectasis — R.A. Mintzer, D.W. Cugell (1982)
• Rounded atelectasis. Clinical experience with 74 patients — G. Hillerdal (1989)
• Rounded atelectasis and respiratory compromise secondary to pergolide use — C.I. Bloom, G.E. Wilson (2009)
• Rounded atelectasis complicated by obstructive pneumonia and pulmonary arterial thrombosis — C.H. Chen, L. Newman (1990)
• Rounded atelectasis: diagnosis by fine-needle aspiration cytology — W.T. Miller, P.K. Gupta, et al. (1992)
• Rounded atelectasis in an asbestos exposed worker — A. Thompson, M. Wills, et al. (2004)

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