Rounded atelectasis in an asbestos exposed worker

Our plain-English summary of Rounded atelectasis in an asbestos exposed worker, by A. Thompson, M. Wills, R. House (Occupational Medicine, 2004).

The study

• Authors: A. Thompson, M. Wills, R. House
• Journal: Occupational Medicine
• Published: 2004;54(7):494-6
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The case history is presented of a 51-year-old electrical power worker with a history of asbestos exposure presenting with rounded atelectasis. No other radiological markers of asbestos exposure were present. A documented history of asbestos exposure and exclusion of other causes of rounded atelectasis led to the diagnosis of asbestos related rounded atelectasis. It is important to understand that rounded atelectasis can be an isolated finding due to asbestos exposure. This facilitates investigation of lung masses of unknown etiology and initiation of appropriate follow up of patients at risk for future development of more debilitating asbestos related pathology.

In plain English

This case report describes one 51-year-old man, seen at St Michael's Hospital in Toronto, who had worked 26 years as an electrical power worker for a hydroelectric company. For 2 years he cut through and removed asbestos covering from cables in transformer vaults and underground cable ducts without personal protective equipment. This exposure ended 24 years before he was seen. The article does not name a fiber type. He had a 20 pack-year smoking history. He was referred for chest discomfort, shortness of breath and an abnormal X-ray. Chest X-ray and CT showed a left lower lobe pleural reaction with rounded atelectasis, a localized collapse at the edge of the lung. X-rays from the previous 5 years had shown no abnormalities, bronchoscopy found no endobronchial lesions or foreign bodies, and no other radiological markers of asbestos exposure were present. The authors judged chronic reflux with aspiration unlikely and concluded that his rounded atelectasis was asbestos related. He was followed to confirm the lesion was stable. He was counselled about an increased risk of mesothelioma and other related cancers given his smoking and asbestos exposure.

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 (one patient)
• Who was studied: One 51-year-old man who had worked for 26 years as an electrical power worker for a hydroelectric company. He was seen at the Occupational Health Unit at St Michael's Hospital, Toronto, Canada. He had a 20 pack-year smoking history and had quit 4 years earlier.
• Exposure: Asbestos exposure over a 2-year period while cutting through and removing asbestos covering from cables in transformer vaults and underground cable ducts. No personal protective equipment was used. The exposure ended 24 years before presentation. No fiber type is named.
• Main results:
  • In this patient, chest X-ray showed a left lower lobe pleural reaction and rounded atelectasis with elevation of the diaphragm. CT showed a similar pleural reaction with atelectasis and a few air bronchograms.
  • In this patient, X-ray reports from the previous 5 years showed no radiological abnormalities.
  • In this patient, bronchoscopy found no endobronchial lesions or foreign bodies.
  • This patient's pulmonary function testing showed a mildly obstructive picture with moderate gas trapping. FVC, FEV1 and FEV1/FVC were lower than predicted at 66, 54 and 66% respectively. Diffusion capacity for carbon monoxide was 83% of predicted.
  • The differential diagnosis was narrowed to a pleural asbestos reaction or chronic reflux with aspiration. Reflux with aspiration was deemed unlikely because the pleural reaction was on the left side and his reflux was well controlled with a proton pump inhibitor.
  • No other asbestos-related markers were present in this patient.
  • The patient was followed by the clinic to ensure the lesion was stable, and the authors state that the longevity of the lesion was confirmed.
  • The patient was counselled about his increased risk of developing mesothelioma and other related cancers given his history of smoking and asbestos exposure.
• The authors' conclusion: The authors concluded that this patient's rounded atelectasis was asbestos related, despite the absence of other asbestos-related markers. They based this on his documented exposure, the exclusion of other causes, and a literature review. They stated that rounded atelectasis can be an isolated finding due to asbestos exposure.

Topics

Medical terms in this study, explained in our Lexicon: Rounded Atelectasis, Asbestos Exposure, Etiology, Pathology.

Related studies

• Rounded atelectasis and its association with asbestos-induced pleural disease — R.A. Mintzer, R.M. Gore, et al. (1981)
• Rounded atelectasis: diagnosis by fine-needle aspiration cytology — W.T. Miller, P.K. Gupta, et al. (1992)
• Rounded atelectasis. Clinical experience with 74 patients — G. Hillerdal (1989)
• The association of asbestos-induced pleural disease and rounded atelectasis — R.A. Mintzer, D.W. Cugell (1982)
• Rounded atelectasis of the lung — G.T. Stathopoulos, M.T. Karamessini, et al. (2005)
• Asbestos-related rounded atelectasis. Radiologic and mineralogic data in 23 cases — C. Voisin, F. Fisekci, et al. (1995)

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