Rounded atelectasis. Clinical experience with 74 patients

Our plain-English summary of Rounded atelectasis. Clinical experience with 74 patients, by G. Hillerdal (Chest, 1989).

The study

• Author: G. Hillerdal
• Journal: Chest
• Published: 1989;95(4):836-41
• Cited by: 73 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. 000093).

Abstract

Rounded atelectasis is an atelectasis of a peripheral part of the lung due to pleural adhesions and fibrosis causing deformation of the lung and bending of some small bronchi. From 1970 to 1986, some 74 patients with rounded atelectasis have been seen at the Lung Department. Sixty-four of these patients had been exposed to asbestos. The lesion was secondary to a benign asbestos pleurisy in nine patients and resulted from a slowly increasing pleural fibrosis in 13 patients; in the remaining 39 patients with exposure to asbestos, rounded atelectasis was a sudden finding, with earlier roentgenograms showing only plaques or being normal. Three patients had bilateral lesions, and one had no fewer than three small rounded atelectases. All of the asbestos-exposed patients were men. Ten patients (four women and six men) had not been exposed to asbestos. Two of these cases occurred after trauma and four after a pleural exudate. One of the latter was the only one which disappeared spontaneously. The lingula was affected in 33 cases, the middle lobe in 16, the right lower lobe in 12, the left lower lobe in 11, the right upper lobe in six, and the left upper lobe (except the lingula) in one. Nine patients underwent surgery. Operation should be avoided; the typical roentgenologic and CT findings combined with negative results of bronchoscopy (and, in some cases, fine-needle biopsy) will suffice to exclude malignancy.

In plain English

This retrospective review covered all 74 patients with rounded atelectasis seen at the Lung Department in Uppsala, Sweden, from 1970 to 1986. Rounded atelectasis is a collapsed, folded part of the outer lung caused by pleural scarring. Sixty-four patients, all men, had been occupationally exposed to asbestos, mostly moderately and intermittently in trades such as construction. Ten patients (four women, six men) denied exposure. In exposed men, the lesion followed benign asbestos pleurisy in nine and slowly progressive pleural fibrosis in 13. Of the remaining exposed men, earlier X-rays showed only plaques in 27, were normal in six, and were unavailable for nine. Thirty-five exposed patients (55 percent) had bilateral progressive pleuroparenchymal fibrosis before or after the lesion appeared. Nine patients died, all asbestos-exposed, three from asbestosis. Only one lesion, in an unexposed patient, disappeared spontaneously. Thoracotomy in nine exposed and two unexposed patients confirmed in every case that the lesion was benign. The authors concluded that operation should be avoided, as typical X-ray and CT findings with negative bronchoscopy (and, in some cases, fine-needle biopsy) suffice to exclude malignancy. They advised follow-up X-rays, first after one to two months.

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 review of all patients with rounded atelectasis seen at one hospital lung department (case series)
• Who was studied: All 74 patients with rounded atelectasis seen at the Lung Department, Akademiska Sjukhuset, Uppsala, Sweden, from 1970 to 1986. 64 were asbestos-exposed, all men, with a mean age of 62.6 years. 10 were not exposed (four women, six men). Findings in 12 of these patients had been reported before.
• Exposure: Occupational asbestos exposure, with no fiber type specified. One insulator had heavy daily exposure. The others reported moderate and intermittent exposure as builders or construction workers (31), plumbers (5), electricians (4), car mechanics (4) and similar trades. Mean length of exposure was 24.6 years and mean latency from first exposure was 36 years.
• Main results:
  • In 9 asbestos-exposed patients, rounded atelectasis followed a benign asbestos pleurisy (pleural exudate) that resulted in pleural fibrosis.
  • In 13 asbestos-exposed patients, a slowly progressive pleural fibrosis gradually led to the rounded atelectasis.
  • Among the 64 asbestos-exposed patients, earlier chest X-rays were not available in 9, were normal two to five years before in 6, and showed only pleural plaques in 27.
  • All 74 patients had 79 rounded atelectases in total: 33 (42 percent) in the lingula, 16 (20 percent) in the middle lobe, 12 (15 percent) in the right lower lobe, 11 (14 percent) in the left lower lobe, 6 (8 percent) in the right upper lobe and 1 (1 percent) in the left upper lobe.
  • In 35 asbestos-exposed patients (55 percent of all those exposed), bilateral progressive pleuroparenchymal fibrosis either preceded the rounded atelectasis or developed after it appeared.
  • In all 10 patients not exposed to asbestos, the rounded atelectasis stayed stable over 3 to 10 years of follow-up, except for one that disappeared spontaneously.
  • Nine patients died during follow-up, all in the asbestos-exposed group.
  • Three of the asbestos-exposed patients died from asbestosis: two one year after the rounded atelectasis appeared and one after four years.
  • In 42 asbestos-exposed patients who were tested, mean vital capacity was 82 percent and mean total lung capacity was 84 percent of predicted. The authors described this as usually slight restriction. The 4 unexposed patients who were tested had lung function within normal limits.
  • Thoracotomy was performed in 9 asbestos-exposed and 2 unexposed patients, and confirmed in all cases that the lesion was benign.
  • Among the 64 asbestos-exposed men, 30 were smokers when the rounded atelectasis appeared, 24 were ex-smokers and 10 had never smoked.
  • For a patient with typical X-ray and CT findings and normal bronchoscopy, the authors advised follow-up with chest X-rays, first after one to two months and then at longer intervals. They noted that malignant tumors can coexist with asbestos-related pleural fibrosis.
• The authors' conclusion: The authors concluded that operation should be avoided. In their view, typical X-ray and CT findings combined with negative bronchoscopy (and, in some cases, fine-needle biopsy) will suffice to exclude malignancy.

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: Rounded Atelectasis, Atelectasis, Fibrosis, Bronchus, Pleurisy, Bilateral, Exudate, Bronchoscopy.

Related studies

• Rounded atelectasis and its association with asbestos-induced pleural disease — R.A. Mintzer, R.M. Gore, et al. (1981)
• The association of asbestos-induced pleural disease and rounded atelectasis — R.A. Mintzer, D.W. Cugell (1982)
• Rounded atelectasis and respiratory compromise secondary to pergolide use — C.I. Bloom, G.E. Wilson (2009)
• Asbestos-related rounded atelectasis. Radiologic and mineralogic data in 23 cases — C. Voisin, F. Fisekci, et al. (1995)
• Rounded atelectasis of the lung — G.T. Stathopoulos, M.T. Karamessini, et al. (2005)
• Rounded atelectasis due to acute exudative effusion. Spontaneous resolution — L.S. Smith, R.F. Schillaci (1984)

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