The radiology of malignant pleural mesothelioma in Western Australia

Our plain-English summary of The radiology of malignant pleural mesothelioma in Western Australia, by S.L. Langlois, J.J. Glancy, D.W. Henderson (Australasian Radiology, 1978).

The study

• Authors: S.L. Langlois, J.J. Glancy, D.W. Henderson
• Journal: Australasian Radiology
• Published: 1978;22(4):305-14
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The radiological finding are described in 12 cases of malignant pleural mesothelioma diagnosed over a three-year period at the Sir Charles Gairdner Hospital in Western Australia. At presentation all showed a unilateral pleural effusion ranging from small to massive in size, with a right : left ratio of 2 : 1; in 8 cases a massive effusion developed at some time in the course of the disease. Pulmonary embolism was initially suspected in two cases and both underwent lower limb venography, emphasizing the similarities in presentation, with chest pain, dyspnoea and a serosanguineous pleural effusion. The sex and age distribution corresponds to that seen in series from other countries, and the radiological findings also closely conform to those reported elsewhere. Pleural nodules were evident in 9 cases, although only in one at presentation, and hilar enlargement was seen in only 4 cases. Soft tissue invasion by neoplasm was uncommonly seen on the x-rays, and rib erosion was not observed in any patient. Other radiological evidence of previous asbestos exposure or other pneumoconiosis was also uncommon and was noted in three cases. An unusual presentation of a malignant pleural mesothelioma in a 27-year-old woman with environmental childhood exposure to asbestos is described in detail, and illustrates the importance of considering mesothelioma in the differential diagnosis of any pleural effusion.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This was a case series from the Sir Charles Gairdner Hospital in Western Australia describing the x-ray findings in 12 new cases of malignant pleural mesothelioma diagnosed from 1973 to 1975. There were 10 men and 2 women, aged 27 to 74. The authors reported that both women had environmental rather than occupational asbestos exposure. All tumours were on one side (8 right, 4 left). Every patient had a pleural effusion (fluid around the lung) on the first x-ray: small in 4, moderate in 3 and massive in 5, with 8 eventually massive. Probable tumour masses were seen in 8 cases (9 in the article's summary), only one on the first film. No pleural calcification or rib invasion was seen. Three patients showed pneumoconiosis: silicosis in 2 and asbestos-related lung fibrosis in 1. Two patients were first thought to have a blood clot in the lung. One patient, a 27-year-old woman, had about 10 years of heavy childhood exposure at Wittenoom. The authors concluded that mesothelioma should be considered in the differential diagnosis of any pleural effusion.

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: Hospital case series: a review of all available x-rays of patients with malignant pleural mesothelioma, with one patient (Case 7) described in detail as a case report
• Who was studied: 12 new cases of malignant pleural mesothelioma diagnosed at the Sir Charles Gairdner Hospital, Western Australia, from 1973 to 1975 inclusive. There were 10 males and 2 females, aged 27 to 74 years (average 53 years).
• Exposure: Asbestos exposure, mostly not quantified. The authors say exposure was documented in a high proportion of cases. Both women had environmental rather than occupational exposure. Case 7 had heavy environmental exposure for about 10 years as a child at Wittenoom, where her father was a miner and asbestos mine tailings were kept in the backyard and used to top-dress the lawn. Case 4 had known heavy exposure 30 years earlier.
• Main results:
  • All 12 tumours were unilateral pleural mesotheliomas, right to left ratio 8 to 4.
  • All patients had a unilateral pleural effusion at the first examination. At presentation it was small in 4, moderate in 3 and massive in 5.
  • Three cases with small to moderate effusions grew despite repeated aspirations, giving eventually 8 massive effusions in the series.
  • Eight cases showed highly probable soft tissue (tumour) masses, but only one (Case 8) on the presenting film. The article's own summary instead says pleural nodules were evident in 9 cases, only one at presentation.
  • Hilar enlargement was seen in 4 cases. It was visible on tomography at presentation in Case 11 and appeared during the disease in at least 3 others.
  • Only Case 3 showed x-ray evidence of extension through the chest wall. Rib invasion was not seen in any case.
  • Pleural calcification was not seen in any case.
  • Of the 12 cases, 3 showed x-ray evidence of pneumoconiosis: silicosis in 2 (Cases 9 and 10) and severe fibrotic lung disease related to asbestos exposure in 1 (Case 4).
  • Two patients (Cases 3 and 7) had bilateral lower limb venography because pulmonary embolism was first suspected.
  • Abdominal masses developed in Cases 6 and 7. Autopsy was not permitted in either. The masses were presumed to be spread of the pleural tumour through the diaphragm.
  • At the hospital, diagnoses rose from 0 to 1 per year in 1970 to 1972, to 2 in 1973, 2 in 1974 and 8 in 1975.
  • In Case 7 (a 27-year-old woman), the surgical specimen was judged a biphasic diffuse malignant mesothelioma. Ferruginous (asbestos) bodies were not found in the small amount of attached lung tissue. She died after 7 months of progressive symptoms, and autopsy was refused.
• The authors' conclusion: The authors concluded that radiologists should consider mesothelioma in all cases of unilateral pleural effusion, irrespective of age, sex and occupational history. They said Case 7 illustrates the importance of considering mesothelioma in the differential diagnosis of any pleural effusion.
• Limitations the authors state:
  • Tumour masses were often hard to see because of the pleural effusion.
  • Suspected nodules on the lateral chest wall in many cases could not be distinguished from encysted effusions.
  • Ultrasound was not used in this series.
  • Autopsy was not permitted in Cases 6 and 7, so the origin of their abdominal masses was not confirmed.

Mines named here

Asbestos mines this study is about. Each mine's page says who ran it, when it worked, and what it produced.

• Wittenoom, Western Australia

All asbestos mines

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleural Effusion, Neoplasm, Asbestos Exposure, Pneumoconiosis, Mesothelioma, Differential Diagnosis.

Related studies

• Prevalence of radiographic asbestosis in crocidolite miners and millers at Wittenoom, Western Australia — W.O. Cookson, N.H. De Klerk, et al. (1986)
• Effects of asbestos and smoking on the levels and rates of change of lung function in a crocidolite exposed cohort in Western Australia — H.S. Alfonso, L. Fritschi, et al. (2004)
• Sputum asbestos bodies and radiographic changes in residents of Wittenoom, Western Australia — A.W. Musk, J.E. Baker, et al. (1983)
• Radiology of asbestosis — A. Solomon (1970)
• Vitamin A and cancer prevention I: observations in workers previously exposed to asbestos at Wittenoom, Western Australia — A.W. Musk, N.H. de Klerk, et al. (1998)
• Malignant pleural and peritoneal mesotheliomas in former miners and millers of crocidolite at Wittenoom, Western Australia — G. Berry, N.H. de Klerk, et al. (2004)

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