Pleuraplaques bei Asbestose

Imaging of

asbestos-related lung and pleural diseases as an endemic exposure in Egypt. A male patient 40 years old, a smoker, working as a concrete board cutter for 20 years. (a) axial mediastinal window, (b) axial lung window, (c) coronal mediastinal window and (d) sagittal mediastinal window non contrast CT scan of the chest showing right sided pleural plaques involving the costal and diaphragmatic pleura with dense curvilinear calcifications denoting benign asbestos related pleural disease.

ejrnm.springeropen.com • CC-by-4.0

Imaging of

asbestos-related lung and pleural diseases as an endemic exposure in Egypt. A 65-year-old male smoker patient, working in ship building for 30 years, was diagnosed as having calcified pleural plaques for 2 years with a latent period of 28 years. Axial CT scan lung and mediastinal windows showing bilateral curvilinear calcified pleural plaques involving the costal pleura

ejrnm.springeropen.com • CC-by-4.0

Asbestos-related

pleural and lung fibrosis in patients with retroperitoneal fibrosis. Pleural masses in the patients with retroperitoneal fibrosis (RPF). A: High-resolution computed tomography scan of the lung of a 55-year-old former pipefitter with RPF; there is a large anterior pleural mass (maximum dimensions of 30 mm × 150 mm) continuing into the mediastinum (arrowheads) and a thinner dorsal diffuse pleural thickening (white arrow) with a rounded atelectasis (black arrow); the patient had undergone left-sided pleural decortication 10 years earlier. B: An anterior mediastinal mass with maximum dimensions of 30 mm in thickness and 190 mm in width (arrowheads), bilateral diffuse pleural thickening (white arrows) with a rounded atelectasis on the right side (black arrow); this 62-year-old RPF patient had worked as a storeman, had used asbestos gloves and sealing tapes and done some pipe insulation. C: A 76-year-old female with RPF worked as a construction cleaner and had had a high level of asbestos exposure; there is a large plaque-like mass with calcifications with maximum dimensions of 27 mm in thickness and 150 in mm width. A smaller paravertebral plaque (white arrow) has no continuity with retroperitoneal fibrosis.

ojrd.biomedcentral.com • CC-by-2.0

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Pleuraplaques bei Asbestose

Asbestose Radiopaedia • CC-by-nc-sa 3.0 • de

Asbestosis refers to later development of diffuse interstitial fibrosis secondary to asbestos fiber inhalation and should not be confused with other asbestos related diseases.

Epidemiology

Asbestosis typically occurs 10-15 years following the commencement of exposure to asbestos and is dose related . Heavy asbestos exposure is predominantly encountered among men, as most exposures are occupational in the setting of construction, mining, or ship/automotive industries.

Clinical presentation

Clinical presentation is insidious and nonspecific with shortness of breath prompting imaging. Alternatively, the presence of asbestosis may become evident when a patient presents with other asbestos related diseases.

Pathology

Asbestosis is histologically very similar to usual interstitial pneumonia (UIP) with the addition of asbestos bodies .

Radiographic features

Plain radiograph

There are no pathognomonic radiological features specific for asbestosis . Chest radiograph may show irregular opacities with a fine reticular pattern. Additional evidence of asbestos exposure such as calcified or noncalcified pleural plaques may be evident.

CT

Appearances of asbestosis vary with the duration and severity of the condition. Early manifestations are largely confined to the peripheral region of the lower zones and are subtle. They include:

centrilobular dot-like opacities: peribronchial fibrosis
intralobular linear opacities: reticulation
subpleural lines (often curvilinear)

These changes may be similar in appearance to dependent atelectasis, especially when located posteriorly, and thus supine and prone scans are recommended .

As the fibrosis progresses, a number of more definite findings are seen, which continue to be particularly subpleural and lower lung zone in distribution. They include:

Pleural effusions and pleural plaques are common manifestations of asbestos-related disease.

Mediastinal lymphadenopathy can sometimes be present.

Treatment and prognosis

There is, unfortunately, no proven treatment for asbestosis, and although termination of exposure is, of course, essential, it is usually far too late as many years have invariably already elapsed .

Cessation of smoking is also mandatory as the two are independent and synergistic risk factors for lung cancer .

Progression of disease is variable and appears related to the degree of exposure. Some patients remain stable for many years whereas other progress to end-stage pulmonary fibrosis rapidly . Causes of death include :

respiratory failure
cor pulmonale
asbestos-related malignancy
- lung cancer
- mesothelioma

Differential diagnosis

Consider other causes of pulmonary fibrosis:

in the absence of pleural plaques or diffuse pleural thickening the differentiation may not be possible on imaging alone
presence of centrilobular dot-like or branching opacities, subpleural lines and parenchymal bands may be helpful, as they are more common in asbestosis than in idiopathic pulmonary fibrosis