Rounded atelectasis complicated by obstructive pneumonia and pulmonary arterial thrombosis

Our plain-English summary of Rounded atelectasis complicated by obstructive pneumonia and pulmonary arterial thrombosis, by C.H. Chen, L. Newman (Chest, 1990).

The study

• Authors: C.H. Chen, L. Newman
• Journal: Chest
• Published: 1990;98(5):1283-5
• Type of article: Case report
• Cited by: 3 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. 004923).

Abstract

A patient with a history of asbestos exposure developed rounded atelectasis. The mass was associated with local bronchial obstruction, obstructive pneumonia and arterial thrombosis. Autopsy demonstrated marked pleural thickening and radiographically inapparent asbestosis. This is the first reported case in which seemingly benign rounded atelectasis not only increased morbidity, but also contributed to mortality through airway obstruction and local arterial thrombosis.

In plain English

This article is a case report about one patient. A 74-year-old white man, a lifelong nonsmoker, had been exposed to asbestos while working for six years as a railroad machinist's helper 34 years earlier. The article does not name a fiber type. In 1987 he developed fever and malaise. Imaging showed a 3 cm rounded mass beside the right heart border, collapse of the right lower lobe, pneumonia, and pleural plaques on both sides. The chest X-ray showed no small opacities of asbestosis (ILO profusion 0/0). Bronchoscopy found the right lower lobe airways compressed from outside, and a needle biopsy of the mass showed only pleural thickening and fibrosis. He died of respiratory failure five months after discharge. Autopsy found pneumonia in both lungs, severe interstitial fibrosis with many ferruginous bodies (asbestosis), a clot nearly blocking the artery to the right lower lobe, and no cancer in the lung or pleura. The authors concluded that rounded atelectasis, usually harmless, contributed to illness and death in this case. They noted that his age and prostate cancer may have raised his risk of infection.

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 (single patient)
• Who was studied: One 74-year-old white man, a lifelong nonsmoker with a history of prostate carcinoma treated with chemotherapy, who fell ill in the summer of 1987; reported from Denver institutions
• Exposure: Asbestos exposure during six years of work as a railroad machinist's helper, 34 years before the illness; no fiber type or dose given
• Main results:
  • Chest radiograph showed a small right pleural effusion, wedge-shaped collapse of the right lower lobe, and a sharply outlined ovoid soft tissue density 3 cm in diameter next to the right cardiac border
  • The chest radiograph showed no small opacities (ILO profusion 0/0), although pleural thickening was suggested on both sides
  • The mass showed no significant radiographic change for at least 18 months, although the surrounding collapse had increased
  • Bronchoscopy showed external compression of all right lower lobe bronchi, with the superior segment nearly totally blocked
  • CT-guided needle biopsy of the mass showed only pleural thickening and fibrosis; the patient refused further diagnostic procedures and refused empiric treatment for malignancy
  • The patient died in respiratory failure five months after hospital discharge
  • Autopsy found pleural and diaphragmatic hyaline plaques, bilateral acute bronchopneumonia, and diffuse severe interstitial fibrosis with numerous ferruginous bodies
  • At autopsy, the pulmonary artery branch to the right lower lobe was nearly completely blocked by a firmly attached clot; no other clots were found
  • Autopsy found no cancer in the pleura or lung tissue, but found prostate adenocarcinoma extending to the bladder
• The authors' conclusion: The authors concluded that, although rounded atelectasis is generally benign, in this case it contributed to the patient's illness and death through airway obstruction and local arterial thrombosis. They described this as the first such reported case. They considered the clot's presence only in the collapsed lobe to make local changes from the pleural mass the more likely cause.
• Limitations the authors state:
  • The authors noted that the patient's age and prostatic carcinoma may also have increased his susceptibility to infection
  • The authors noted that pulmonary vascular thrombosis can occur with severe pneumonia, an alternative explanation for the clot

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Rounded Atelectasis, Asbestos Exposure, Autopsy, Pleural Thickening.

Related studies

• In Situ Pulmonary Artery Thrombosis: Unrecognized Complication of Radiation Therapy — J. Ahuja, G.S. Shroff, et al. (2020)
• Rounded atelectasis associated with pulmonary lymphangioleiomyomatosis — K. Kishi, S. Homma, et al. (2005)
• 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. Clinical experience with 74 patients — G. Hillerdal (1989)
• Rounded atelectasis of the lung — G.T. Stathopoulos, M.T. Karamessini, et al. (2005)

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