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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
... 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.
... All of these asbestos fibres have been linked to carcinoma, mesothelioma, and lung fibrosis [45]. Asbestos industrial production began in the 1850s; however, by the mid-20th Century, it was evident that asbestos exposure increases the risk of non-malignant inflammatory (pleural effusion, pleural plaques, rounded atelectasis, and asbestosis) and malignant (mesothelioma and bronchogenic carcinoma) pulmonary diseases [45][46][47][48][49]. At least 40 countries, including the US, have banned or severely restricted asbestos use [50]. ...
Occupational lung diseases are lung conditions caused or made worse by materials when a person is exposed to a workplace. The diagnosis of an occupational disease is important for workers' decision to continue work and for their eligibility under compensation programmes. We revisit the existing lung diseases that are closely associated with the occupation at the workplace namely occupational asthma, silicosis, black lung disease, farmers’ lung disease, asbestos-linked disease, and hypersensitivity pneumonitis. Occupational lung diseases contribute toward global health and economic impacts. Prevention and control of occupational lung diseases require a collaborative effort among employers, workers, occupational physicians, pulmonary physicians, industrial hygienists, and members from other disciplines.
... Parenchymal bands (perpendicular to pleura), round atelectasis, and subpleural curvilinear lines (parallel to the chest wall) are other chest HRCT findings (Fig. 4). In addition, fibrotic changes of small airways and deposition of asbestos fibers can produce a mosaic pattern that can be visualized on CT scans [33,36,37]. Ground glass opacities and pulmonary nodules are usually not present in this disease. ...
... They are mainly the consequence of the fusion of pleural linings secondary to a benign exudative effusion or less commonly due to confluence of plaques or extension of parenchymal fibrotic changes to the pleural layers [8]. They may cause functional lung impairment and result in the formation of parenchymal bands and round atelectasis, which enhances on contrast CT studies but does not uptake FDG on nuclear studies [33,37,40]. Pleural thickening can involve up to 25% of the chest wall and appears as uninterrupted pleural thickening of 3 mm or more on CT images [17,33,35]. ...
... Benign asbestos-induced pleural effusions are very common abnormalities and usually develop after 5 to 20 years of initial exposure to asbestos fibers, even with minimal concentration [33,37]. They can be unilateral or bilateral and tend to be eosinophil-rich hemorrhagic exudates which typically resolve within 4 months, leading to diffuse pleural thickening [1,33,41]. ...
Purpose of Review
This review article aims to highlight the common and uncommon imaging features of work-related and environmental lung disease to help the clinicians suspect diagnosis in patients with occult or known exposures to inhalational potent substances.
Recent Findings
Occupational and environmental lung disease are the most frequent work-related illness in the USA with a recent resurgence mainly due to inadequate exposure control, prolonged working hours, developing industries, and new antigens. Failure to accurately diagnose and promptly manage these lung disorders can lead to long-term and irreversible health conditions. Several case reports have documented misdiagnosis of these lung disorders which could be due to underestimation of their prevalence.
Summary
It is critical for radiologist and clinicians to recognize the classic and uncommon imaging features of occupational and environmental lung diseases. Accurate elicitation of occupational history is a key point for differentiation in this patient population.
... They are focal areas of pleural thickening generally affecting parietal pleura mostly seen on posterolateral chest wall between the seventh and tenth ribs, lateral chest wall between the sixth and ninth ribs, the dome of the diaphragm (virtually pathognomonic) where they follows rib contour and diaphragm. [2] Sometimes, they enter lobar fissure and invade mediastinal pleura. Both apices and costophrenic angles are typically spared. ...
... [4] The differential diagnosis for pleural plaques should include adipose tissue, rib fracture, companion shadows for ribs, and other pleural masses such as metastases. [2] Asbestos pleural plaque being a marker of asbestos exposure is used for medical surveillance and worker compensation claims. Asbestosis rarely occurs in the absence of pleural plaques; hence, pleural plaques in a patient with interstitial lung disease may provide a clue in making the diagnosis of asbestosis whenever patient does not give history of known asbestos exposure. ...
... [1] CDH occurs in one of 2000-3000 births. [2] ...
... The upper lung suffers a greater concentration of particulates and pathogens that can overwhelm its meager antiprotease defenses [92] ro-apical part of the upper lobe, changes to lower lobe consolidation when there is immunosuppression with HIV [95]. In asbestosis, the size and needle like shape of the asbestos fiber (length 100 μm, diameter 30 μm) favors entrapment in the lower lobes [96][97][98]. ...
... 2 Diffuse pleural thickening is less specific for asbestos exposure and results from thickening and fibrosis of the visceral pleura. 3 The clinical significance of pleural abnormalities has been investigated in previous studies. [4][5][6][7][8] Lilis et al investigated 1584 asbestos insulation workers between 1981 and 1983. ...
... 27 Our results support the previous reports but also reveal that pleural plaques in the anterior portion, which could be underestimated on chest radiography, 25 are also common on chest CT. Since the lymphatic pathway of asbestos fibres is a possible pathogenesis of pleural plaques, 3 anterior involvements could be explained by an association with the internal mammary (parasternal) lymph node chain. Understanding the CT image characteristics of pleural abnormalities and their associated demographic features may help improve the accuracy of their assessment. ...
Background:
The prevalence of pleural abnormalities in the general population is an epidemiologically important index of asbestos exposure, which has not been investigated since a radiography-based study in 1980.
Methods:
We examined 2633 chest CT scans (mean 59.2 years, 50% female) from the Framingham Heart Study (FHS) for the presence and image characteristics of pleural plaques and diffuse pleural thickening. Demographics and pulmonary function were stratified by the presence of pleural abnormalities in association with interstitial lung abnormalities.
Results:
Pleural abnormalities were present in 1.5% (95% CI 1.1% to 2.1%). Pleural lesions were most commonly bilateral (90.0%), multiple (77.5%), calcified (97.5%) and commonly involved posterior (lower: 92.5%, middle: 87.5%), anterior (upper: 77.5%, middle: 77.5%) and diaphragmatic areas (72.5%). Participants with pleural abnormalities were significantly older (75.7 years, p <0.0001), male (92.5%, p <0.0001), former or current smokers (80.0%, p <0.001) with higher pack-years (33.3, p <0.0001). No significant reduction was noted in pulmonary function measures (p=0.07-0.94) when adjusted for the associated covariates, likely due to small number of cases with pleural abnormalities. Information about prior history of asbestos exposure and occupation was not available.
Conclusions:
Pleural plaques and diffuse pleural thickening are present on CT in 1.5% of the FHS cohort. The current prevalence of the pleural abnormalities is smaller than that reported in the previous population-based study using chest radiography, likely representing lower asbestos exposure in recent decades. The posterior portion of the pleura is most frequently involved but the anterior portion is also commonly involved.
