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(a) Axial CT scan of an asbestos-exposed person shows a left-sided pleural effusion (arrow). (b) Axial CT scan obtained 2 years later shows circumferential pleural thickening that extends into the major fissure (straight arrow) and contains flecks of calcification (curved arrow).
Source publication
Asbestos-related neoplastic and nonneoplastic diseases of the lungs and pleura range from pleural effusion and pleural plaques to lung cancer and malignant mesothelioma. Pleural effusions are typically hemorrhagic exudates of mixed cellularity but do not typically contain asbestos bodies. The classic distribution of pleural plaques seen on chest ra...
Contexts in source publication
Context 1
... pleural thickening is less specific for as- bestos exposure because other causes of exudative effusions can lead to it. It results from thickening and fibrosis of the visceral pleura, which leads to fusion with the parietal pleura (Fig 7), and is pre- ceded by benign pleural effusion (1) (Fig 8). His- tologically, there is similarity between pleural thickening and plaques, except that fusion of the pleural layers is suggestive of more intense inflam- mation (22). ...
Context 2
... effusions are also commonly seen. Other benign features such as pleural plaques or calcification can be seen in conjunc- tion (Fig 28), but mesothelioma is not known to arise from plaques. CT shows contraction of the hemithorax with or without mediastinal shift; ex- tension along fissures; invasion of the chest wall; invasion of mediastinal structures, including peri- cardium, great vessels, trachea, esophagus, and nodes (48); diaphragmatic invasion; and meta- static spread to nodes, the contralateral lung, or the liver (Figs 29 -34). ...
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Citations
... When calcification turns evident, PPs are pathognomonic of asbestos-related pleural fibrosis [28]. PPs are usually present in varying numbers and sizes and are distributed over the posterolateral chest wall, the dome of the diaphragm and the mediastinal pleura [29]. Their presence is confirmed by CT scanning. ...
The term “asbestos” is used to refer to a group of silicate minerals that often break down into fibres and whose inhalation over time can cause a number of diseases, especially pleuropulmonary diseases. While the most serious complications are malignant diseases, inhalation of these fibres can also cause benign pleural diseases such as round atelectasis, pleural plaques, diffuse pleural thickening and non-malignant asbestos pleural effusion.
Although asbestos is banned in most developed countries (in the European Union, since 2002), it is still used in developing countries. Despite these restrictions, the prevalence of diseases due to inhalation remains high due to the long latency period between the onset of exposure and the onset of disease.
In this paper we review benign pleural diseases induced by asbestos exposure, update the diagnostic criteria for these disorders, and describe the approaches suggested so far to differentiate them from malignant pleural diseases.
... Previous researches indicated that tumor margin is closely linked to tumor development and prognosis [19,20]. Malignant tumors may show a more lobulated outline [19]. ...
... Previous researches indicated that tumor margin is closely linked to tumor development and prognosis [19,20]. Malignant tumors may show a more lobulated outline [19]. The ill-defined mass contour demonstrated by CT images indicated an infiltrative process [20]. ...
Background/Purpose
It is challenging to determine the pancreatic neuroendocrine tumors (pNETs) malignancy grade noninvasively. We aim to establish a CT - based diagnostic nomogram to predict the tumor grade of pNETs.
Methods
The patients with pathologically confirmed pNETs were recruited in two centers between January 2009 and November 2020. PNETs were subdivided into three grades according to the 2017 World Health Organization classification: low-grade G1 NETs, intermediate-grade G2 NETs, and high-grade G3 NETs. The features on the CT images were carefully evaluated. To build the nomogram, multivariable logistic regression analysis was performed on the imaging features selected by LASSO to generate a combined indicator for estimating the tumor grade.
Results
A total of 162 pNETs (training set n = 114, internal validation set n = 21, external validation set, n = 48) were admitted, including 73 (45.1%) G1 and 89 (54.9%) G2/3. A nomogram comprising the tumor margin, tumor size, neuroendocrine symptoms and the enhanced ratio on portal vein phase images of tumor was established to predict the malignancy grade of pNETs. The mean AUC for the nomogram was 0.848 (95% CI, 0.918–0.953). Application of the developed nomogram in the internal validation dataset still yielded good discrimination (AUC, 0.835; 95% CI, 0.915–0.954). The externally validated nomogram yielded a slightly lower AUC of 0.770 (95% CI, 0.776–0.789).
Conclusions
The nomogram model demonstrated good performance in preoperatively predicting the malignancy grade of pNETs, and can provide clinicians with a simple, practical, and non-invasive tool for personalized management of pNETs patients.
Graphical abstract
... Rather, the occurrence of unique cases with lower rates compared to regional/ national residents (gastric dysplasia, colon polyposis, thyroid nodules suggests that genetic/epigenetic predisposing factors might have driven the onset and progression in these individuals [41][42][43][44]. Workplace chemical risk factors other than asbestos might have been (co)responsible for the observed non-ARD outcomes [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] (Figure 2). Our findings might be of guidance for taking proper safety, health surveillance, and regulative actions. ...
Purpose: Asbestos-containing materials are found in industries as raw materials and in the living environment as dispersed waste. There is a need to assess the impact of non-dusty low-level compact asbestos on health in different job settings and whether other risk factors could synergize. To characterize the whole disease outline (deadly/non-deadly/disabling) of workers at risk of asbestos exposure. To discern the role of smoke and extra-work asbestos on the outcomes. To discern the role job type on the risk of ARD and diseases potentially associated. Methods: A retrospective observational cohort study was performed. A broad research database was generated with anamnestic, job and diagnostic data of past asbestos workers (N=108). An epidemiology database was built up to evaluate comparatively the plausibility and novelty of our findings. RR were calculated for disease/category of disease in relation to residential asbestos, smoke and occupational groups/businesses to evaluate the predictivity of associations. Results: Pleural plaques, asbestosis, prostate cancer and lung nodules occurred at a significantly higher rate than generally observed. Respiratory/ metabolic diseases were more frequent in our cohort than expected. ARD occurrence was not modified by exposure to residential asbestos or smoke. Manufacturing jobs were at higher risk of ARD and respiratory diseases. Production workers were at higher risk of metabolic syndrome. Conclusions: The processing manner of ACM is critical for the release of (few) inhalable fibres and the asbestos-related pathological consequences. Our findings are of concern for workers and residents of poorly managed settings engaged by industrial or natural erosion of ACM.
... The scientific and medical literature is replete with hundreds of papers addressing various aspects and questions related to asbestos. Additionally, scientific conferences and debates are held annually, focusing on different facets of asbestos use and associated risks [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Regrettably, in our country, this topic is not extensively discussed, despite its universal recognition as one of the most challenging issues that require attention. ...
Asbestos has been extensively researched as one of the most hazardous materials to human health in the past century. Despite its universal recognition as a challenging problem, the topic is unfortunately not widely discussed in our country. However, the city authority of Skopje has undertaken a significant campaign focused on identifying and removing asbestos-containing materials from various buildings in the city. This initiative represents the largest effort of its kind in the country thus far. The campaign involved the development of methodologies and the analysis of samples collected from different buildings in Skopje. A systematic analysis was conducted on 50 samples collected from 21 public buildings in Skopje, utilizing techniques such as optical microscopy, infrared spectroscopy, X-ray diffraction, and scanning electron microscopy (SEM). The results revealed the presence of asbestos in 33 of the analyzed samples. Notably, asbestos was not detected in only two buildings. These findings indicate that asbestos is present in the building materials of practically all the inspected structures, suggesting its likely presence in many other buildings within the city and throughout the country. Of particular concern is the confirmed presence of asbestos in kindergartens, as this exposes the young population to potential asbestos-related health risks.
... P leural plaques (PPs), a specific manifestation of asbestos exposure, often appear on the parietal pleura as localized hyalinized collagen fibers in calcified or noncalcified forms. [1][2][3] The exact mechanism of PP formation remains unclear. 2,4 However, the likelihood of developing PP is associated with the duration and cumulative exposure to asbestos. ...
... [1][2][3] The exact mechanism of PP formation remains unclear. 2,4 However, the likelihood of developing PP is associated with the duration and cumulative exposure to asbestos. 5 Despite this, PP can also form after minimal exposure. ...
Purpose
Pleural plaques (PPs) are morphologic manifestations of long-term asbestos exposure. The relationship between PP and lung function is not well understood, whereas the time-consuming nature of PP delineation to obtain volume impedes research. To automate the laborious task of delineation, we aimed to develop automatic artificial intelligence (AI)–driven segmentation of PP. Moreover, we aimed to explore the relationship between pleural plaque volume (PPV) and pulmonary function tests.
Materials and Methods
Radiologists manually delineated PPs retrospectively in computed tomography (CT) images of patients with occupational exposure to asbestos (May 2014 to November 2019). We trained an AI model with a no-new-UNet architecture. The Dice Similarity Coefficient quantified the overlap between AI and radiologists. The Spearman correlation coefficient ( r ) was used for the correlation between PPV and pulmonary function test metrics. When recorded, these were vital capacity (VC), forced vital capacity (FVC), and diffusing capacity for carbon monoxide (DLCO).
Results
We trained the AI system on 422 CT scans in 5 folds, each time with a different fold (n = 84 to 85) as a test set. On these independent test sets combined, the correlation between the predicted volumes and the ground truth was r = 0.90, and the median overlap was 0.71 Dice Similarity Coefficient. We found weak to moderate correlations with PPV for VC (n = 80, r = −0.40) and FVC (n = 82, r = −0.38), but no correlation for DLCO (n = 84, r = −0.09). When the cohort was split on the median PPV, we observed statistically significantly lower VC ( P = 0.001) and FVC ( P = 0.04) values for the higher PPV patients, but not for DLCO ( P = 0.19).
Conclusion
We successfully developed an AI algorithm to automatically segment PP in CT images to enable fast volume extraction. Moreover, we have observed that PPV is associated with loss in VC and FVC.
... The pathognomonic radiological feature is the pleural plaque. The pleural plaques are found in the posterolateral chest wall between the seventh and tenth ribs, the lateral chest wall between the sixth and ninth ribs, and the diaphragm dome and mediastinal pleura [72]. The false-positive findings due to extrapleural fat or muscle with pleural plaques are mitigated by a CT scan. ...
Asbestos is a naturally occurring mineral with a wide range of application in various industries. It has been linked with respiratory and non-respiratory illnesses. We aim to discuss the various pathologies caused due to asbestos exposure with succinct coverage of all areas of asbestosis study.
Asbestos continues to be used in many industries. Currently, cosmetic products contaminated by asbestos raise the problem of continuous exposure to a proven carcinogen. Various conditions like effusions, plaques, pneumoconiosis, mesothelioma, and lung cancer are associated with it. The development of respiratory problems has a dose–response relationship with asbestos. Currently, no pharmacological therapy has demonstrated efficacy in the treatment of asbestosis.
The diagnosis of asbestos-related illnesses should have a clear history of exposure to the mineral and suggestive clinical and imaging findings. As the therapy of asbestos-related illnesses is not curative, the main aim should be to limit asbestos exposure. Besides, alternative materials should be promoted instead of asbestos to reduce its usage further.
... These fibers are used in construction and manufacturing, such as brake linings, pads, and insulation. By the mid-20th century, asbestos exposure had drastically increased the risk of lung and pleural diseases, including non-malignant (e.g., pleural effusion, pleural plaque, rounded atelectasis, and asbestosis) and malignant (lung cancer and mesothelioma) diseases [40][41][42]. Occupational asbestos exposure is associated with a five-fold increase in the risk of lung cancer [43,44], and the risk of lung cancer has been noted to increase with increased exposure to asbestos [44]. Malignant mesothelioma (mainly malignant pleural mesothelioma) is the most common malignant occupational respiratory disease, and 23,000 cases of malignant mesothelioma were caused by asbestos exposure in 2015 [45]. ...
Ambient pollutants and occupational pollutants may cause and exacerbate various lung and respiratory diseases. This review describes lung and respiratory diseases in relation to ambient pollutants, particularly particulate matter (PM2.5), and occupational air pollutants, excluding communicable diseases and indoor pollutants, including tobacco smoke exposure. PM2.5 produced by combustion is an important ambient pollutant. PM2.5 can cause asthma attacks and exacerbations of chronic obstructive pulmonary disease in the short term. Further, it not only carries a risk of lung cancer and death, but also hinders the development of lung function in children in the long term. It has recently been suggested that air pollution, such as PM2.5, is a risk factor for severe coronavirus disease (COVID-19). Asbestos, which causes asbestosis, lung cancer, and malignant mesothelioma, and crystalline silica, which cause silicosis, are well-known traditional occupational pollutants leading to pneumoconiosis. While work-related asthma (WRA) is the most common occupational lung disease in recent years, many different agents cause WRA, including natural and synthetic chemicals and irritant gases. Primary preventive interventions that increase awareness of pollutants and reduce the development and exacerbation of diseases caused by air pollutants are paramount to addressing ambient and occupational pollution.
... Asbestos-induced conditions include non-neoplastic and neoplastic pleural and lung diseases ranging from pleural effusion, thickening, plaques to malignant mesothelioma, and lung cancer. Pleural plaques are the most common disease [48,49,55]. ...
... On MRI, pleural plaques are hypo to isointense to skeletal muscle on T1-weighted, and hypointense on T2-weighted images. These findings are representative of fibrosis and internal calcification (Table 4) [48,49,55]. ...
A heterogeneous group of tumors can affect the posteromedial chest wall. They form diverse groups of benign and malignant (primary or secondary) pathologies that can arise from different chest wall structures, i.e., fat, muscular, vascular, osseous, or neurogenic tissues. Chest radiography is very nonspecific for the characterization of chest wall lesions. The modality of choice for the initial assessment of the chest wall lesions is computed tomography (CT). More advanced cross-sectional modalities such as magnetic resonance imaging (MRI) and positron emission tomography (PET) with fluorodeoxyglucose are usually used for further characterization, staging, treatment response, and assessment of recurrence. A systematic approach based on age, clinical history, and radiologic findings is required for correct diagnosis. It is essential for radiologists to be familiar with the spectrum of lesions that might affect the posteromedial chest wall and their characteristic imaging features. Although the imaging findings of these tumors can be nonspecific, cross-sectional imaging helps to limit the differential diagnosis and determine the further diagnostic investigation (e.g., image-guided biopsy). Specific imaging findings, e.g., location, mineralization, enhancement pattern, and local invasion, occasionally allow a particular diagnosis. This article reviews the posteromedial chest wall anatomy and different pathologies. We provide a combination of location and imaging features of each pathology. We will also explore the role of imaging and its strengths and limitations for diagnosing posteromedial chest wall lesions.
... Rounded atelectasis refers to the presence of focal lung collapse that accompanies a variety of conditions. (4) It is typically associated with pleural disease, therefore being a relatively common finding in patients with asbestos exposure, (5) in whom it is usually associated with a previous exudative pleural effusion or is the result of adjacent pleural fibrosis or diffuse pleural thickening. (4)(5)(6)(7) On axial imaging, rounded atelectasis appears as a round or oval mass that is located peripherally and abuts the pleural surface, which is usually thickened, with or without effusion. ...
... (4) It is typically associated with pleural disease, therefore being a relatively common finding in patients with asbestos exposure, (5) in whom it is usually associated with a previous exudative pleural effusion or is the result of adjacent pleural fibrosis or diffuse pleural thickening. (4)(5)(6)(7) On axial imaging, rounded atelectasis appears as a round or oval mass that is located peripherally and abuts the pleural surface, which is usually thickened, with or without effusion. Rounded atelectasis is characteristically associated with a reduction in the volume of the involved lobe and with a curvilinear appearance of the vascular and bronchial structures adjacent to the lesion margins, forming the comet tail sign ( Figure S1). ...
... Rounded atelectasis is characteristically associated with a reduction in the volume of the involved lobe and with a curvilinear appearance of the vascular and bronchial structures adjacent to the lesion margins, forming the comet tail sign ( Figure S1). (2,5) Because rounded atelectasis represents collapsed lung parenchyma, it can show intense enhancement after contrast agent injection on both CT and MRI, a useful feature in differentiating it from lung neoplasms, which usually do not show such intense contrast agent uptake on contrast-enhanced imaging studies. ...
Effective communication among members of medical teams is an important factor for early and appropriate diagnosis. The terminology used in radiology reports appears in this context as an important link between radiologists and other members of the medical team. Therefore, heterogeneity in the use of terms in reports is an important but little discussed issue. This article is the result of an extensive review of nomenclature in thoracic radiology, including for the first time terms used in X-rays, CT, and MRI, conducted by radiologists from Brazil and Portugal. The objective of this review of medical terminology was to create a standardized language for medical professionals and multidisciplinary teams.
... (11,40) Asbestosis Asbestos-related fibrosing ILD usually occurs 20 years or more after exposure. The changes of asbestosis are more pronounced in the lower lobes and subpleurally, and honeycombing can occur, albeit only in advance cases; imaging findings of asbestosis can be indistinguishable from those of various clinical entities, including IPF. (41,42) Akira et al. (42) studied HRCT scans of patients with asbestosis or IPF and concluded that subpleural dot-like or branching opacities, subpleural curvilinear lines, mosaic attenuation, and parenchymal bands are significantly more common in the former than in the latter. Although the parenchymal abnormalities found in patients with asbestosis can also be found in patients with other diseases, pleural plaques are characteristic of exposure to asbestos, being found in up to 80% of patients with asbestosis on radiographic studies ( Figure 4). ...
... Although the parenchymal abnormalities found in patients with asbestosis can also be found in patients with other diseases, pleural plaques are characteristic of exposure to asbestos, being found in up to 80% of patients with asbestosis on radiographic studies ( Figure 4). (41) The diagnosis of asbestosis is based on a thorough clinical and occupational history. ...
Many conditions result in chronic interstitial lung disease (ILD), being classifed as fbrosing ILDs, including idiopathic pulmonary fbrosis, connective tissue diseases, sarcoidosis, and fbrotic hypersensitivity pneumonitis. HRCT plays an important role in the clinical evaluation of fbrosing ILDs. Current treatment perspectives are encouraging and reinforce the need for HRCT scans of adequate technical quality for early detection of fbrosing ILD. Despite efforts in this regard, the signifcance and management of imaging fndings of early interstitial lung abnormalities have yet to be clarifed. After identifcation of CT fndings consistent with fbrosing ILD, radiologists must be able to identify characteristic morphological patterns and, in some cases, features of specifc clinical entities. In cases in which HRCT features are not suffciently specifc for a defnitive diagnosis, HRCT can aid in selecting the best site for surgical lung biopsy. CT follow-up is useful for identifying progressive fbrosing ILDs and detecting complications unrelated to the underlying disease, including infections, acute exacerbations, and neoplasms. Automated quantifcation tools have clinical applicability and are likely to be available for use in imaging analysis in the near future. In addition, incorporation of CT evaluation
into scoring systems based on clinical and functional parameters for staging fbrosing disease is likely to become valuable in determining prognosis. Knowledge of the clinical applications of CT evaluation is essential for specialists managing patients with fbrosing ILD and can have a positive impact on the clinical course of the disease.
