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Albano GD, Rodolico V, Di Franco S, Re GL, Midiri M, Malta G, Cannizzaro E, Argo A, Zerbo S. Asbestos exposure determined 357 days after death through autopsy: a report of a multidisciplinary approach. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00838-z. [PMID: 38806807 DOI: 10.1007/s12024-024-00838-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
Asbestosis is an interstitial lung disease caused by the inhalation of asbestos fibers and poses a significant risk to individuals working in construction, shipping, mining, and related industries. In a forensic context, postmortem investigations are crucial for accurate diagnosis, for which the gold standard is the histopathological examination. This case report describes the autopsy and related investigations conducted on an 84-year-old man, nearly one year (357 days) after his death. After a post-mortem CT scan, an autoptic investigation was performed, followed by histopathological, immunohistochemical, and scanning electron microscopy examinations. The integration of the evidence from these examinations with previously available personal and clinical information conclusively confirmed the diagnosis of asbestosis. We demonstrated the efficacy and reliability of our diagnostic protocol in detecting asbestosis and asbestos fibers and excluding mesothelioma even in decomposed tissues. According to our findings autopsy remains the diagnostic gold standard in cases of suspected asbestosis within a forensic context, even 1 year after death, therefore it is always highly recommended, even in cases where the body has decomposed.
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Affiliation(s)
- Giuseppe Davide Albano
- Institute of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy.
| | - Vito Rodolico
- Pathological Anatomy Department, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Simone Di Franco
- Institute of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy
| | - Giuseppe Lo Re
- Radiology Department, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Mauro Midiri
- Institute of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy
| | - Ginevra Malta
- Institute of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy
| | - Emanuele Cannizzaro
- Institute of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy
| | - Antonina Argo
- Institute of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy
| | - Stefania Zerbo
- Institute of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy
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Giménez Palleiro A, Mazzini SP, Franquet T. Basic HRCT patterns in diffuse interstitial lung disease. RADIOLOGIA 2022; 64 Suppl 3:215-226. [PMID: 36737161 DOI: 10.1016/j.rxeng.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/10/2022] [Indexed: 02/05/2023]
Abstract
The term interstitial lung disease (also called diffuse infiltrative lung disease) encompasses a heterogeneous group of processes characterized by the appearance of an inflammatory reaction in the alveolar wall that can be triggered by different antigens. This group of diseases represents a wide spectrum of processes of diverse etiologies, and sometimes the nomenclature can be confusing. High-resolution computed tomography (HRCT) is the imaging method of choice for the evaluation and diagnosis of interstitial lung diseases because it confirms the presence of lung disease and establishes the correct diagnosis for associated complications. Nevertheless, the definitive diagnosis of these entities requires the imaging findings to be interpreted together with their clinical manifestations and histological confirmation. In this group of diseases, HRCT findings play a fundamental role, being especially important for avoiding unnecessary biopsies. For these reasons, clinicians need to be familiar with the basic radiologic patterns associated with this group of lung diseases: septal, reticular, nodular, ground-glass, cystic, and consolidations. This chapter describes the features of these patterns and ways that they can present, and it reviews some of the most common interstitial lung diseases, emphasizing the predominant radiologic patterns in each of them.
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Affiliation(s)
- A Giménez Palleiro
- Servicio de Radiodiagnóstico, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - S P Mazzini
- Servicio de Radiodiagnóstico, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - T Franquet
- Servicio de Radiodiagnóstico, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Giménez Palleiro A, Mazzini S, Franquet T. Patrones básicos en la TCAR de la enfermedad pulmonar intersticial difusa. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Tandon YK, Walkoff L. Imaging Patterns in Occupational Lung Disease—When Should I Consider? Radiol Clin North Am 2022; 60:979-992. [DOI: 10.1016/j.rcl.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ströker L, Peldschus K, Herold R, Harth V, Preisser AM. Restrictions of VC and DLCO in relation to asbestos-related computed tomographic findings quantified by ICOERD-based parameters. BMC Pulm Med 2022; 22:236. [PMID: 35725440 PMCID: PMC9208103 DOI: 10.1186/s12890-022-02022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even almost 30 years after the ban on the use of asbestos in Germany, the effects of asbestos are still highly relevant in everyday clinical practice in occupational medicine. The aim of this study was to further investigate the significance of essential parameters of both pulmonary function diagnostics and imaging techniques (low-dose HR-TCT) for the prevention and early detection of asbestos-related morphological and functional lung changes. METHODS Data from spirometry, body plethysmography and diffusion capacity, as well as CT images of the thorax, were retrospectively studied from 72 patients examined between 2017 and 2019 at the Institute for Occupational and Maritime Medicine (ZfAM), Hamburg, Germany. The subjects were divided into four subgroups according to the presence of comorbidities (concomitant cardiac diseases, obstructive ventilatory disorder, pulmonary function pattern consistent with emphysema, and no other pulmonary or cardiac diseases). These subgroups were analysed in addition to the overall collective. The CT images were evaluated according to the International Classification of Occupational and Environmental Respiratory Diseases (ICOERD) with radiological expertise. In addition, some asbestos-related parameters were newly quantified, and corresponding scores were defined based on ICOERD. Statistical analysis included the use of correlations and fourfold tables with calculation of Spearman's rho (ρ), Cohen's κ, and accuracy. RESULTS Vital capacity (VC) is slightly reduced in the total collective compared to the normal population (mean 92% of predicted value), while diffusion capacity for CO (DLCO) shows predominantly pathological values, mean 70% of the respective predicted value. The CO transfer coefficient (DLCO/VA), which refers to alveolar volume (VA), also shows slightly decreased values (mean 87% pred.). Seventy-nine percent of patients (n = 57) had signs of pulmonary fibrosis on CT scans, and pleural plaques appeared in 58 of 72 patients (81%). Of the newly quantified additional parameters, particularly frequently described findings are subpleural curvilinear lines (SC, n = 39) and parenchymal bands (PB, n = 29). VC correlates well with the expression of pleural plaques (ρ = - 0.273, P < 0.05), and DLCO measures show a better correlation with fibrosis score (ρ = - 0.315, P < 0.01). A third, newly developed score, which includes the extent of pleural plaques and additional subpleural parameters instead of fibrosis parameters, shows significant correlations for both VC and DLCO (ρ = - 0.283, - 0.274, resp.; both P < 0.05). DISCUSSION The importance of spirometry (VC) and diffusion capacity measurement (DLCO) as essential diagnostic procedures for the early detection of asbestos-related changes ‒ also including patients with relevant concomitant cardiac or pulmonary diseases ‒ was confirmed. Significant and better correlations between lung function changes (VC and DLCO) and abnormal CT findings are seen when parenchymal bands (PB), subpleural curvilinear lines (SC), and rounded atelectasis (RA) are quantitatively included into the evaluation, in addition to assessing the extent of pleural plaques alone. Therefore, when assessing CT images according to ICOERD, these parameters should also be quantified.
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Affiliation(s)
- Lennart Ströker
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kersten Peldschus
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Robert Herold
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alexandra Marita Preisser
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
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Laurent F, Benlala I, Dournes G, Gramond C, Thaon I, Clin B, Brochard P, Gislard A, Andujar P, Chammings S, Gallet J, Lacourt A, Delva F, Paris C, Ferretti G, Pairon JC. Interstitial Lung Abnormalities Detected by CT in Asbestos-Exposed Subjects Are More Likely Associated to Age. J Clin Med 2021; 10:jcm10143130. [PMID: 34300298 PMCID: PMC8307087 DOI: 10.3390/jcm10143130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: the aim of this study was to evaluate the association between interstitial lung abnormalities, asbestos exposure and age in a population of retired workers previously occupationally exposed to asbestos. Methods: previously occupationally exposed former workers to asbestos eligible for a survey conducted between 2003 and 2005 in four regions of France, underwent chest CT examinations and pulmonary function testing. Industrial hygienists evaluated asbestos exposure and calculated for each subject a cumulative exposure index (CEI) to asbestos. Smoking status information was also collected in this second round of screening. Expert radiologists performed blinded independent double reading of chest CT-scans and classified interstitial lung abnormalities into: no abnormality, minor interstitial findings, interstitial findings inconsistent with UIP, possible or definite UIP. In addition, emphysema was assessed visually (none, minor: emphysema <25%, moderate: between 25 and 50% and severe: >50% of the lung). Logistic regression models adjusted for age and smoking were used to assess the relationship between interstitial lung abnormalities and occupational asbestos exposure. Results: the study population consisted of 2157 male subjects. Interstitial lung abnormalities were present in 365 (16.7%) and emphysema in 444 (20.4%). Significant positive association was found between definite or possible UIP pattern and age (OR adjusted =1.08 (95% CI: 1.02–1.13)). No association was found between interstitial abnormalities and CEI or the level of asbestos exposure. Conclusion: presence of interstitial abnormalities at HRCT was associated to aging but not to cumulative exposure index in this cohort of former workers previously occupationally exposed to asbestos.
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Affiliation(s)
- François Laurent
- Faculté de Médecine, Université de Bordeaux, F-33000 Bordeaux, France; (I.B.); (G.D.); (P.B.)
- Service d’Imagerie Médicale Radiologie Diagnostique et Thérapeutique, CHU de Bordeaux, F-33000 Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Université de Bordeaux, F-33000 Bordeaux, France
- Correspondence: ; Tel.: +33-5-2454-9136
| | - Ilyes Benlala
- Faculté de Médecine, Université de Bordeaux, F-33000 Bordeaux, France; (I.B.); (G.D.); (P.B.)
- Service d’Imagerie Médicale Radiologie Diagnostique et Thérapeutique, CHU de Bordeaux, F-33000 Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Université de Bordeaux, F-33000 Bordeaux, France
| | - Gael Dournes
- Faculté de Médecine, Université de Bordeaux, F-33000 Bordeaux, France; (I.B.); (G.D.); (P.B.)
- Service d’Imagerie Médicale Radiologie Diagnostique et Thérapeutique, CHU de Bordeaux, F-33000 Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Université de Bordeaux, F-33000 Bordeaux, France
| | - Celine Gramond
- Epicene Team, Bordeaux Population Health Research Center, INSERM UMR 1219, Université de Bordeaux, F-33000 Bordeaux, France; (C.G.); (J.G.); (A.L.); (F.D.)
| | - Isabelle Thaon
- Centre de Consultation de Pathologies Professionnelles, CHRU de Nancy, Université de Lorraine, F-54000 Nancy, France;
| | - Bénédicte Clin
- Service de Santé au Travail et Pathologie Professionnelle, CHU Caen, F-14000 Caen, France;
- Faculté de Médecine, Université de Caen, ANTICIPE, INSERM U1086, F-14000 Caen, France
| | - Patrick Brochard
- Faculté de Médecine, Université de Bordeaux, F-33000 Bordeaux, France; (I.B.); (G.D.); (P.B.)
- Service de Médecine du Travail et de Pathologies Professionnelles, CHU de Bordeaux, F-33000 Bordeaux, France
| | - Antoine Gislard
- Centre de Consultations de Pathologie Professionnelle, UNIROUEN, UNICAEN, ABTE, F-76000 Rouen, France;
- CHU de Rouen, Normandie Université, F-76031 Rouen, France
| | - Pascal Andujar
- Equipe GEIC20, INSERM U955, F-94000 Créteil, France; (P.A.); (J.-C.P.)
- Faculté de Santé, Université Paris-Est Créteil, F-94000 Créteil, France
- Service de Pathologies Professionnelles et de l’Environnement, Centre Hospitalier Intercommunal Créteil, Institut Santé-Travail Paris-Est, F-94000 Créteil, France
- Institut Interuniversitaire de Médecine du Travail de Paris-Ile de France, F-94000 Créteil, France;
| | - Soizick Chammings
- Institut Interuniversitaire de Médecine du Travail de Paris-Ile de France, F-94000 Créteil, France;
| | - Justine Gallet
- Epicene Team, Bordeaux Population Health Research Center, INSERM UMR 1219, Université de Bordeaux, F-33000 Bordeaux, France; (C.G.); (J.G.); (A.L.); (F.D.)
| | - Aude Lacourt
- Epicene Team, Bordeaux Population Health Research Center, INSERM UMR 1219, Université de Bordeaux, F-33000 Bordeaux, France; (C.G.); (J.G.); (A.L.); (F.D.)
| | - Fleur Delva
- Epicene Team, Bordeaux Population Health Research Center, INSERM UMR 1219, Université de Bordeaux, F-33000 Bordeaux, France; (C.G.); (J.G.); (A.L.); (F.D.)
| | - Christophe Paris
- Service de Santé au Travail et Pathologie Professionnelle, CHU Rennes, F-35000 Rennes, France;
- Institut de Recherche en Santé, Environnement et Travail, INSERM U1085, F-35000 Rennes, France
| | - Gilbert Ferretti
- INSERM U 1209 IAB, F-38700 La Tronche, France;
- Domaine de la Merci, Université Grenoble Alpes, F-38706 La Tronche, France
- Service de Radiologie Diagnostique et Interventionnelle Nord, CHU Grenoble Alpes, CS 10217, F-38043 Grenoble, France
| | - Jean-Claude Pairon
- Equipe GEIC20, INSERM U955, F-94000 Créteil, France; (P.A.); (J.-C.P.)
- Faculté de Santé, Université Paris-Est Créteil, F-94000 Créteil, France
- Service de Pathologies Professionnelles et de l’Environnement, Centre Hospitalier Intercommunal Créteil, Institut Santé-Travail Paris-Est, F-94000 Créteil, France
- Institut Interuniversitaire de Médecine du Travail de Paris-Ile de France, F-94000 Créteil, France;
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Walkoff L, Hobbs S. Chest Imaging in the Diagnosis of Occupational Lung Diseases. Clin Chest Med 2021; 41:581-603. [PMID: 33153681 DOI: 10.1016/j.ccm.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Imaging plays a crucial role in the diagnosis and monitoring of occupational lung diseases (OLDs); however, the sensitivity and specificity of detection and diagnosis vary greatly depending on the imaging modality used. There is substantial overlap in appearance with non-occupation-related entities. OLDs should be considered in the differential even in the absence of a provided exposure history. Because many findings are not specific, a multidisciplinary approach is important in arriving at the diagnosis and will continue to be important as workplace-related pulmonary diseases evolve with changing industrial practices and workplace regulations.
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Affiliation(s)
- Lara Walkoff
- Divisions of Thoracic and Cardiovascular Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| | - Stephen Hobbs
- Radiology Informatics and Integrated Clinical Operations, Division of Cardiovascular and Thoracic Radiology, UK HealthCare Imaging Informatics, University of Kentucky, 800 Rose Street, HX 302, Lexington, KY 40536, USA
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Nogami S, J-P NA, Nogami M, Matsui T, Ngatu NR, Tamura T, Kusaka Y, Itoh H, Suganuma N. Radiographic diagnosis of Pneumoconioses by AIR Pneumo-trained physicians: Comparison with low-dose thin-slice computed tomography. J Occup Health 2020; 62:e12141. [PMID: 33176059 PMCID: PMC7384989 DOI: 10.1002/1348-9585.12141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The Asian Intensive Reader of Pneumoconiosis (AIR Pneumo) is a training program designed to improve diagnostic skills for chest radiographies (CXRs) in accordance with the ILO/ICRP 2000. The purpose was to determine the prevalence of occupational environmental pulmonary disease findings in construction workers on thin-slice computed tomography (thin-slice CT), and to compare the diagnostic performance with CXR evaluated by AIR Pneumo-trained physicians. METHODS Ninety-seven male construction workers underwent low-dose thin-slice CT and CXR on the same day. NIOSH B reader and a board-certified radiologist each interpreted the thin-slice CTs independently. The concordant findings on thin-slice CT were established as the reference standard and were statistically compared with CXRs. Four physicians interpreted CXRs independently according to the ILO/ICRP 2000. RESULTS Of the 97 cases, nine showed irregular or linear opacities, and 44 had pleural plaques on thin-slice CT. Five, four, three, and two of nine cases with irregular opacity were detected by the four readers on CXRs, respectively. Sixteen, 14, 9, and 5 of the 44 cases with pleural plaques were detected by the four readers, respectively. Specificities for irregular opacities ranged from 94% to 100%, and those for pleural plaques were from 86% to 96%. CONCLUSIONS Thin-slice CT-detected irregular opacity was found in 9.3%, whereas pleural plaque was found in 45.4% among the construction workers. Chest radiography showed acceptable performance in classifying pneumoconiotic opacities according to ILO/ICRP 2000 by the AIR Pneumo and/or NIOSH-certified physicians.
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Affiliation(s)
- Shoko Nogami
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Naw Awn J-P
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Munenobu Nogami
- Department of Radiology, Kobe University Hospital, Kobe, Japan
| | - Tomomi Matsui
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Nlandu Roger Ngatu
- Department of Public Health, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Taro Tamura
- Fukui City Public Health Center, Fukui, Japan
| | - Yukinori Kusaka
- Department of Radiology, Faculty of Medicine, University of Fukui, Japan
| | - Harumi Itoh
- Department of Radiology, Faculty of Medicine, University of Fukui, Japan
| | - Narufumi Suganuma
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Japan
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Cha YK, Kim JS, Kwon JH. Quantification of pleural plaques by computed tomography and correlations with pulmonary function: preliminary study. J Thorac Dis 2018; 10:2118-2124. [PMID: 29850115 DOI: 10.21037/jtd.2018.04.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aims of this study were to quantify pleural plaque volumes (PPVs) by computed tomography (CT) and investigate relations between PPV and pulmonary function after excluding other factors that might affect pulmonary function. Methods Twenty-six subjects with pleural plaques and pulmonary function test (PFT) results among 1,544 subjects that registered with the Korea Environment Corporation for asbestos damage relief from January 2011 to December 2015 were included. Subjects with CT evidence of lung diseases and/or previous surgery were excluded. PPVs were measured by tracing the outlines of all pleural plaques on CT images. Patients were allocated to three groups by PPV, as follows, <10, 10-20, or ≥20 mL, and the PFT results of these groups were analyzed and compared. Simple linear regression analysis and multiple regression analysis were used to evaluate correlations between PPV and PFT variables. Results No significant relationship was found between total PPV and pulmonary function indices or between PPV groups and PFT results (P>0.05). However, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and diffusing capacity of the lung for carbon monoxide (DLCO) values in the higher PPV group (≥20 mL) tended to be lower, indicating a restrictive pattern of pulmonary function. Conclusions We quantified PPV on CT and found out higher PPV tended to exhibit a restrictive pattern. However, pleural plaques alone were not found to be significantly associated with pulmonary function.
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Affiliation(s)
- Yoon Ki Cha
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University, Goyang, South Korea
| | - Jeung Sook Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University, Goyang, South Korea
| | - Jae Hyun Kwon
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University, Goyang, South Korea
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Macía-Suárez D, Sánchez-Rodríguez E, Lopez-Calviño B, Diego C, Pombar M. Low-voltage chest CT: another way to reduce the radiation dose in asbestos-exposed patients. Clin Radiol 2017; 72:797.e1-797.e10. [PMID: 28478929 DOI: 10.1016/j.crad.2017.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/26/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
AIM To assess whether low voltage chest computed tomography (CT) can be used to successfully diagnose disease in patients with asbestos exposure. MATERIALS AND METHODS Fifty-six former employees of the shipbuilding industry, who were candidates to receive a standard-dose chest CT due to their occupational exposure to asbestos, underwent a routine CT. Immediately after this initial CT, they underwent a second acquisition using low-dose chest CT parameters, based on a low potential (80 kV) and limited tube current. The findings of the two CT protocols were compared based on typical diseases associated with asbestos exposure. The kappa coefficient for each parameter and for an overall rating (grouping them based on mediastinal, pleural, and pulmonary findings) were calculated in order to test for correlations between the two protocols. RESULTS A good correlation between routine and low-dose CT was demonstrated for most parameters with a mean radiation dose reduction of up to 83% of the effective dose based on the dose-length product between protocols. CONCLUSIONS Low-dose chest CT, based on a limited tube potential, is useful for patients with an asbestos exposure background. Low-dose chest CT can be successfully used to minimise the radiation dose received by patients, as this protocol produced an estimated mean effective dose similar to that of an abdominal or pelvis plain film.
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Affiliation(s)
- D Macía-Suárez
- Complexo Hospitalario Universitario de Ferrol, Avda Residencia, s/n, CP: 15405, Ferrol (A Coruña), Spain.
| | - E Sánchez-Rodríguez
- Facultad de Biología, Campus universitario Lagoas, Marcosende, CP: 36200, Vigo, Spain
| | - B Lopez-Calviño
- Unidad de epidemiología clínica y estadística, Complejo Hospitalario Universitario A Coruña-INIBIC, As Xubias de Arriba, 84, CP: 15006, A Coruña, Spain
| | - C Diego
- Complexo Hospitalario Universitario de Ferrol, Avda Residencia, s/n, CP: 15405, Ferrol (A Coruña), Spain
| | - M Pombar
- Servizo de Radiofísica e Protección Radiolóxica, Complexo Hospitalario Universitario de Santiago de Compostela, Trav. Choupana, s/n, CP: 15706, Santiago de Compostela (Acoruña), Spain
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Abstract
Many diseases affect the pleural space in both adults and children, including common diseases such as pneumonia, cancer and heart failure. Pleural effusion is the most common manifestation of pleural disease, and it is often a secondary effect of another disease process. Imaging plays a crucial role in the management of pleural disease. Chest radiography often remains the first examination in the assessment of these patients. Depending on the clinical context, the optimal imaging technique for further evaluation might be computed tomography (CT), ultrasound (US), or magnetic resonance (MR).
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Gevenois PA, De Vuyst P, Dedeire S, Cosaert J, Vande Weyer R, Struyven J. Conventional and High-Resolution CT in Asymptomatic Asbestos-Exposed Workers. Acta Radiol 2016. [DOI: 10.1177/028418519403500306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To compare the value of conventional CT (CCT) and high-resolution CT (HRCT) to detect benign asbestos-related diseases, 159 exposed workers with a normal chest radiography were imaged by both techniques. Pleural plaques were detected in a total of 59 cases (37.1%). Ten cases (16.9%) were detected by CCT only and one case (1.7%) by HRCT only. Pulmonary lesions compatible with parenchymal asbestosis were detected by HRCT in 20 cases, whereas CCT showed abnormalities in 45% of these. Rounded atelectasis was equally recognized by both techniques. The results confirm that in a subject with a normal chest radiography, HRCT is a better diagnostic tool to demonstrate lesions of asbestosis. On the other hand, HRCT is insufficient to exclude the presence of pleural plaques. When HRCT does not reveal pleural abnormalities, CCT should be performed.
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Cha YK, Kim JS, Kim Y, Kim YK. Radiologic Diagnosis of Asbestosis in Korea. Korean J Radiol 2016; 17:674-83. [PMID: 27587956 PMCID: PMC5007394 DOI: 10.3348/kjr.2016.17.5.674] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 05/17/2016] [Indexed: 11/29/2022] Open
Abstract
Asbestosis is the most important change noted in the lung parenchyma after environmental and occupational exposure to asbestos fibers. It is characterized by diffuse interstitial pulmonary fibrosis. In Korea, the incidence of asbestosis will continue to increase for many years to come and the government enacted the Asbestos Damage Relief Law in 2011 to provide compensation to those suffering from asbestos-related diseases. Radiologic evaluation is necessary for diagnosis of asbestosis, and radiologists play a key role in this process. Therefore, it is important for radiologists to be aware of the various imaging features of asbestosis.
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Affiliation(s)
- Yoon Ki Cha
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea
| | - Jeung Sook Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea
| | - Yookyung Kim
- Department of Radiology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul 07985, Korea
| | - Yoon Kyung Kim
- Department of Radiology, Gachon University Gil Medical Center, Gachon University, Incheon 21565, Korea
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Kim YK, Kim JS, Lee KW, Yi CA, Goo JM, Jung SH. Multidetector CT Findings and Differential Diagnoses of Malignant Pleural Mesothelioma and Metastatic Pleural Diseases in Korea. Korean J Radiol 2016; 17:545-53. [PMID: 27390546 PMCID: PMC4936177 DOI: 10.3348/kjr.2016.17.4.545] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/21/2016] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD). Materials and Methods The authors reviewed the MDCT images of 167 patients, 103 patients with MPM and 64 patients with MPD. All 167 cases were pathologically confirmed by sonography-guided needle biopsy of pleura, thoracoscopic pleural biopsy, or open thoracotomy. CT features were evaluated with respect to pleural effusion, pleural thickening, invasion of other organs, lung abnormality, lymphadenopathy, mediastinal shifting, thoracic volume decrease, asbestosis, and the presence of pleural plaque. Results Pleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD. Conclusion Awareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD.
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Affiliation(s)
- Yoon Kyung Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon 21565, Korea
| | - Jeung Sook Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Chin A Yi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Soon-Hee Jung
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
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15
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Lee EK, Kim JS, Kim Y, Park JS. CT Findings in People Who Were Environmentally Exposed to Asbestos in Korea. J Korean Med Sci 2015; 30:1896-901. [PMID: 26713068 PMCID: PMC4689837 DOI: 10.3346/jkms.2015.30.12.1896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 08/19/2015] [Indexed: 11/20/2022] Open
Abstract
Asbestos related pleuropulmonary disease has been emerging health problem for recent years. It can cause variable clinical symptoms and radiological abnormalities. However, there has been no report for their characteristics in subjects who were environmentally exposed to asbestos. We reviewed the CT images of 35 people who were environmentally exposed to asbestos in Chungnam province, Korea. The study result showed high incidence of pleural plaque and pulmonary fibrosis on chest CT (94% and 77%, respectively). The common CT findings of lung parenchymal lesions were as follows: centrilobular opacities (94%), subpleural dot-like or branching opacities (80%), interlobular septal thickening (57%), intralobular interstitial thickening (46%), parenchymal bands (43%) and subpleural curvilinear line (29%). There were no significant differences in the prevalence of pulmonary fibrosis and pleural plaques according to sex, age and duration of exposure. In conclusion, pleural plaque and pulmonary fibrosis are common asbestos-related CT finding in the exposed people. Asbestos related lung parenchymal CT findings in the participants with environmental exposure show similar to those observed in the occupational exposure.
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Affiliation(s)
- Eun Kyoung Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jeung Sook Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Yookyung Kim
- Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Jai Soung Park
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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16
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Kim Y, Myong JP, Lee JK, Kim JS, Kim YK, Jung SH. CT Characteristics of Pleural Plaques Related to Occupational or Environmental Asbestos Exposure from South Korean Asbestos Mines. Korean J Radiol 2015; 16:1142-52. [PMID: 26357506 PMCID: PMC4559786 DOI: 10.3348/kjr.2015.16.5.1142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022] Open
Abstract
Objective This study evaluated the CT characteristics of pleural plaques in asbestos-exposed individuals and compared occupational versus environmental exposure groups. Materials and Methods This study enrolled 181 subjects with occupational exposure and 98 with environmental exposure from chrysotile asbestos mines, who had pleural plaques confirmed by a chest CT. The CT scans were analyzed for morphological characteristics, the number and distribution of pleural plaques and combined pulmonary fibrosis. Furthermore, the CT findings were compared between the occupational and environmental exposure groups. Results Concerning the 279 subjects, the pleural plaques were single in 2.2% and unilateral in 3.6%, and showed variable widths (range, 1-20 mm; mean, 5.4 ± 2.7 mm) and lengths (5-310 mm; 72.6 ± 54.8 mm). The chest wall was the most commonly involved (98.6%), with an upper predominance on the ventral side (upper, 77.8% vs. lower, 55.9%, p < 0.001) and a lower predominance on the dorsal side (upper, 74.9% vs. lower, 91.8%, p = 0.02). Diaphragmatic involvement (78.1%) showed a right-side predominance (right, 73.8% vs. left, 55.6%, p < 0.001), whereas mediastinal plaques (42.7%) were more frequent on the left (right, 17.6% vs. left, 39.4%, p < 0.001). The extent and maximum length of plaques, and presence and severity of combined asbestosis, were significantly higher in the occupational exposure group (p < 0.05). Conclusion Pleural plaques in asbestos-exposed individuals are variable in number and size; and show a predominant distribution in the upper ventral and lower dorsal chest walls, right diaphragm, and left mediastinum. Asbestos mine workers have a higher extent of plaques and pulmonary fibrosis versus environmentally exposed individuals.
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Affiliation(s)
- Yookyung Kim
- Department of Radiology, School of Medicine, Ewha Womans University, Seoul 07985, Korea
| | - Jun-Pyo Myong
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jeong Kyong Lee
- Department of Radiology, School of Medicine, Ewha Womans University, Seoul 07985, Korea
| | - Jeung Sook Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Yoon Kyung Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon 21565, Korea
| | - Soon-Hee Jung
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
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Sangani RG, Ghio AJ, Parker JE. Pleural plaques in smoking-associated fibrosis and pulmonary asbestosis. Int J Chron Obstruct Pulmon Dis 2015; 10:869-70. [PMID: 25999705 PMCID: PMC4427072 DOI: 10.2147/copd.s83564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Rahul G Sangani
- Department of Pulmonary and Critical Care Medicine, West Virginia University, Morgantown, WV, USA
| | - Andrew J Ghio
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, US Environmental Protection Agency, Chapel Hill, NC, USA
| | - John E Parker
- Department of Pulmonary and Critical Care Medicine, West Virginia University, Morgantown, WV, USA
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18
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Norbet C, Joseph A, Rossi SS, Bhalla S, Gutierrez FR. Asbestos-related lung disease: a pictorial review. Curr Probl Diagn Radiol 2014; 44:371-82. [PMID: 25444537 DOI: 10.1067/j.cpradiol.2014.10.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/01/2014] [Accepted: 10/24/2014] [Indexed: 11/22/2022]
Abstract
Asbestos exposure can lead to a variety of adverse effects in the thorax. Although currently in the western world, levels of exposure are kept in check by strict regulations, history of previous asbestos exposure continues to have an effect on many, owing to the latent nature of the pathophysiological response of the body to the inhaled fibers. The adverse effects of asbestos generally fall under 3 categories: pleural disease, lung parenchymal disease, and neoplastic disease. Effects on the pleura include pleural effusions, plaques, and diffuse pleural thickening. In the parenchyma, rounded atelectasis, fibrotic bands, and asbestosis are observed. Differentiating asbestosis from other forms of interstitial lung diseases, such as idiopathic pulmonary fibrosis, usual interstitial pneumonia, smoking-related lung disease, and mixed interstitial lung diseases, is important because the prognosis, course of disease, and management of the patient should be tailored based on the specific etiology of the disease. In this review, imaging findings specific to asbestosis are discussed. Finally, exposure to asbestos can lead to neoplastic disease such as pleural mesothelioma, peritoneal mesothelioma, and bronchogenic carcinoma. The purpose of this article is to review the effects of asbestos exposure in the thorax, pathophysiology of these responses, and disease course. Particular emphasis is placed on the radiographic appearance of the disease, discussion of various imaging modalities and their utility, and the role of imaging in the management of patients with previous asbestos exposure and asbestos-related pulmonary disease.
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Affiliation(s)
| | - Amanda Joseph
- Department of Radiology, University of New Mexico, Albuquerque, NM
| | - Santiago S Rossi
- Centro de Diagnostico Dr. Enrique Rossi, Buenos Aires, Argentina
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19
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Henderson DW, Jones ML, De Klerk N, Leigh J, Musk AW, Shilkin KB, Williams VM. The Diagnosis and Attribution of Asbestos-related Diseases in an Australian Context: Report of the Adelaide Workshop on Asbestos-related Diseases. October 6–7, 2000. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2013; 10:40-6. [PMID: 15070024 DOI: 10.1179/oeh.2004.10.1.40] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Predictions of future cases of mesothelioma in Australia to the year 2020 are in the order of a total of 10,000 new cases. Compensation claims are testing the attribution in a particular case between occupational asbestos exposure and lung cancer. The cost of the problem necessitates clarifying and standardizing the criteria for a confident diagnosis of asbestos-related disease. The possibility of differences in criteria that determine attribution of asbestos to a disease prompted a consensus meeting of pathologists, epidemiologists, physicians, oncologists, radiologists, and others to define current thinking and to agree on an Australian document based on the scientific evidence for establishing diagnoses and attribution data of asbestos-related diseases in Australia. The participants' findings are reported.
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20
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Notes from the 2012 Annual Meeting of the Korean Society of Thoracic Radiology: asbestos-related thoracic diseases. J Thorac Imaging 2013; 28:W49-55. [PMID: 23478512 DOI: 10.1097/rti.0b013e31828834a0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Abstract
Pleural disease is now recognized as an important subspecialty of pulmonary medicine, with increasing provision being made for specialist services and procedures. In response, the field of pleural imaging has advanced in recent years, especially with regard to ultrasound. Salient multimodality imaging techniques are discussed.
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Affiliation(s)
- Chloe Mortensen
- Department of Radiology, Southmead Hospital, Bristol BS10 5NB, UK
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22
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Low-Dose Computed Tomography (LDCT) in Workers Previously Exposed to Asbestos. J Comput Assist Tomogr 2013; 37:626-30. [PMID: 23863542 DOI: 10.1097/rct.0b013e31828e1b8e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Ameille J. Les différentes pathologies pleuropulmonaires liées à l’amiante : définitions, épidémiologie et évolution. Rev Mal Respir 2012; 29:1035-46. [DOI: 10.1016/j.rmr.2012.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 02/17/2012] [Indexed: 01/09/2023]
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Claude-Desroches M, Bierry G, Touitou-Gottenberg D, Golmard JL, Grenier PA, Beigelman-Aubry C. Focal dependent pleural thickening at MDCT: pleural lesion or functional abnormality? Diagn Interv Imaging 2012; 93:360-4. [PMID: 22542210 DOI: 10.1016/j.diii.2012.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the characteristics of reversible focal pleural thickenings (PTs) mimicking real plaques, that firstly suggest asbestos exposure or pleural metastasis; to propose an imaging strategy and propose an explanation for their mechanism of formation. PATIENTS AND METHODS Retrospective review of data from 19 patients with PTs fitting the description of pleural plaques at chest computed tomography (CT) and presenting modifications (clearance or appearance) of at least one PT at an additional chest examination in prone position. RESULTS A total of 152 PTs were recorded on the first chest CT examinations with a range of two to 19 pleural opacities per patient. All PTs had a posterior distribution in the lower lobes. On the additional acquisitions, 144 PTs disappeared. Seventeen patients presented complete regression of PTs and two patients presented persistence of eight PTs. CONCLUSION Additional low dose acquisition in prone position should be performed in all patients presenting with focal PT in a dependent and basal location. This may allow to exclude a pleural plaque in case of asbestos exposure but also a pleural metastasis in oncologic patients. These reversible dependent PTs could be related to physiological focal accumulation of lymphatic fluid in subpleural area.
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Affiliation(s)
- M Claude-Desroches
- Department of Radiology, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47/83, boulevard de l'Hôpital, 75651 Paris, France
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25
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Ameille J, Rosenberg N, Matrat M, Descatha A, Mompoint D, Hamzi L, Atassi C, Vasile M, Garnier R, Pairon JC. Asbestos-related diseases in automobile mechanics. THE ANNALS OF OCCUPATIONAL HYGIENE 2012; 56:55-60. [PMID: 21965465 PMCID: PMC3678990 DOI: 10.1093/annhyg/mer066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE Automobile mechanics have been exposed to asbestos in the past, mainly due to the presence of chrysotile asbestos in brakes and clutches. Despite the large number of automobile mechanics, little is known about the non-malignant respiratory diseases observed in this population. The aim of this retrospective multicenter study was to analyse the frequency of pleural and parenchymal abnormalities on high-resolution computed tomography (HRCT) in a population of automobile mechanics. METHODS The study population consisted of 103 automobile mechanics with no other source of occupational exposure to asbestos, referred to three occupational health departments in the Paris area for systematic screening of asbestos-related diseases. All subjects were examined by HRCT and all images were reviewed separately by two independent readers; who in the case of disagreement discussed until they reached agreement. Multiple logistic regression models were constructed to investigate factors associated with pleural plaques. RESULTS Pleural plaques were observed in five cases (4.9%) and interstitial abnormalities consistent with asbestosis were observed in one case. After adjustment for age, smoking status, and a history of non-asbestos-related respiratory diseases, multiple logistic regression models showed a significant association between the duration of exposure to asbestos and pleural plaques. CONCLUSIONS The asbestos exposure experienced by automobile mechanics may lead to pleural plaques. The low prevalence of non-malignant asbestos-related diseases, using a very sensitive diagnostic tool, is in favor of a low cumulative exposure to asbestos in this population of workers.
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Affiliation(s)
- Jacques Ameille
- AP-HP, Unité de pathologie professionnelle, Hôpital Raymond Poincaré, 92380 Garches, France.
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26
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Elshazley M, Shibata E, Hisanaga N, Ichihara G, Ewis AA, Kamijima M, Ichihara S, Sakai K, Sato M, Kondo M, Hasegawa Y. Pleural plaque profiles on the chest radiographs and CT scans of asbestos-exposed Japanese construction workers. INDUSTRIAL HEALTH 2011; 49:626-633. [PMID: 21828957 DOI: 10.2486/indhealth.ms1268] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pleural plaques are asymptomatic focal thickenings of the pleura and considered the hallmark of asbestos exposure. However, it is often difficult to detect pleural plaques on chest x-rays (CXR). In a retrospective study, using chest CT scans of 140 Japanese asbestos-exposed construction workers who have probable or definite findings of pleural plaque on CXR; firstly, we proposed plaque morphology-based classification for CXR findings, and then we examined if those classified findings could be confirmed as pleural plaques on CT scans. Our morphology-based classification of pleural plaque findings included nine types. The percentages of confirmed pleural plaques on CT scans by type (number of confirmed pleural plaque on CT/number of observed on CXR) were 93% (40/43) for straight, 89% (56/63) for diamond, 88% (7/8) for double, 83% (19/23) for tapered medially, 80% (20/25) for parallel, 77% (23/30) for crescent, 79% (11/14) for tenting, 72% (18/25) for tapered-laterally (long type), and 0% (0/9) for tapered-laterally (short type). When added to the ILO classification, morphology-based classification of CXR pleural plaque findings makes its detection easier and hence chest radiograph continues to be a suitable tool for screening asbestos-related pleural plaques based on its simplicity, low radiation exposure, wide availability and cost-effectiveness.
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Affiliation(s)
- Momen Elshazley
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan.
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Yang HY, Wang JD, Chen PC, Lee JJ. Pleural plaque related to asbestos mining in Taiwan. J Formos Med Assoc 2011; 109:928-33. [PMID: 21195893 DOI: 10.1016/s0929-6646(10)60142-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Revised: 09/25/2008] [Accepted: 10/31/2008] [Indexed: 12/12/2022] Open
Abstract
A 78-year-old woman complained of twisting-like pain in her left lower chest. During physical examination, friction rubbing was noted in both lungs. Chest radiography showed extensive bilateral pleural calcification. High-resolution computed tomography confirmed the presence of bilateral calcified pleural plaques. The patient had worked at a Japanese asbestos factory in Taiwan for 1 year when she was 16 years old. Her job involved picking out asbestos fibers from crushed asbestos minerals, but no protective equipment was used at that time. This is believed to be the first reported case of asbestos-related disease in Taiwan that resulted from asbestos mining. We also summarize the history of domestic asbestos mining, importation of asbestos, and trends in asbestos use in Taiwan.
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Affiliation(s)
- Hsiao-Yu Yang
- Department of Occupational Medicine, Buddhist Tzu Chi General Hospital, Taipei, Taiwan
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28
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Nogueira CR, Nápolis LM, Bagatin E, Terra-Filho M, Müller NL, Silva CIS, Rodrigues RT, Neder JA, Nery LE. Lung diffusing capacity relates better to short-term progression on HRCT abnormalities than spirometry in mild asbestosis. Am J Ind Med 2011; 54:185-93. [PMID: 21298694 DOI: 10.1002/ajim.20922] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pulmonary function tests (PFT), particularly spirometry and lung diffusing capacity for carbon monoxide (DL(CO) ), have been considered useful methods for the detection of the progression of interstitial asbestos abnormalities as indicated by high-resolution computed tomography (HRCT). However, it is currently unknown which of these two tests correlates best with anatomical changes over time. METHODS In this study, we contrasted longitudinal changes (3-9 years follow-up) in PFTs at rest and during exercise with interstitial abnormalities evaluated by HRCT in 63 ex-workers with mild-to-moderate asbestosis. RESULTS At baseline, patients presented with low-grade asbestosis (Huuskonen classes I-II), and most PFT results were within the limits of normality. In the follow-up, most subjects had normal spirometry, static lung volumes and arterial blood gases. In contrast, frequency of DL(CO) abnormalities almost doubled (P < 0.05). Twenty-three (36.5%) subjects increased the interstitial marks on HRCT. These had significantly larger declines in DL(CO) compared to patients who remained stable (0.88 vs. 0.31 ml/min/mm Hg/year and 3.5 vs. 1.2%/year, respectively; P < 0.05). In contrast, no between-group differences were found for the other functional tests, including spirometry (P > 0.05). CONCLUSIONS These data demonstrate that the functional consequences of progression of HRCT abnormalities in mild-to-moderate asbestosis are better reflected by decrements in DL(CO) than by spirometric changes. These results might have important practical implications for medico-legal evaluation of this patient population.
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Affiliation(s)
- Cristiano Rabelo Nogueira
- Respiratory Division, Federal University of São Paulo (UNIFESP), Rua Botucatu 740, São Paulo, SP, Brazil
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30
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Kradin RL, Digumarthy SR, Baggish AL, Mark EJ. Case records of the Massachusetts General Hospital. Case 12-2010. An 89-year-old man with progressive dyspnea. N Engl J Med 2010; 362:1522-31. [PMID: 20410518 DOI: 10.1056/nejmcpc0910930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Richard L Kradin
- Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, USA
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31
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Clinical and HRCT screening of heavily asbestos-exposed workers. Int Arch Occup Environ Health 2009; 83:47-54. [PMID: 19756698 DOI: 10.1007/s00420-009-0462-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 08/24/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To characterize asbestosis today and to clarify the indications for high-resolution computed tomography (HRCT) in the surveillance of heavily exposed workers. METHODS Six hundred and twenty-seven workers were screened and HRCT findings were classified and divided in two groups: pulmonary fibrosis (n = 86) and no fibrosis (n = 541). RESULTS Most (65/86 = 76%) of the detected fibrosis cases were mild. The magnitude of asbestos exposure showed an unexpected inverse relation with fibrosis. In multivariate analyses, age, forced expiratory volume in 1 s/forced vital capacity ratio, and poor diffusing capacity were associated with HRCT fibrosis, but asbestos exposure was not. CONCLUSIONS Asbestosis seems to be characterized by mild fibrosis today even in heavily exposed workers. To avoid radiation exposure in HRCT, age and lung function data may be used only to a limited extent to select imaging candidates. Selection and recollection biases may distort the relation between asbestos exposure and fibrosis.
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Mastrangelo G, Ballarin MN, Bellini E, Bicciato F, Zannol F, Gioffrè F, Zedde A, Tessadri G, Fedeli U, Valentini F, Scoizzato L, Marangi G, Lange JH. Asbestos exposure and benign asbestos diseases in 772 formerly exposed workers: dose-response relationships. Am J Ind Med 2009; 52:596-602. [PMID: 19533676 DOI: 10.1002/ajim.20713] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Since previous studies have provided conflicting results, we investigated the relationship between the risk of benign asbestos-related diseases and different aspects of asbestos exposure in previous asbestos workers who underwent low-dose computed tomography (CT). METHODS CT scans were carried out in 772 subjects. A questionnaire was employed to collect data on smoking habits and duration, peak and cumulative exposure, and time since first exposure to asbestos. Multiple logistic regression models with stepwise selection of variables were used to evaluate the associations. RESULTS Fourteen (1.8%) cases of asbestosis, 187 (24.2%) of pleural plaques (PP), and 50 (6.5%) of diffuse pleural thickening (DPT) were found. The significant risk factors were: cumulative exposure for asbestosis (P for trend = 0.004); time since first exposure (P for trend <0.001), and peak exposure (P for trend <0.001) for PP; and time since first exposure for DPT (P for trend = 0.024). CONCLUSIONS Parenchymal asbestosis and PP are associated with different aspects of asbestos exposure. DPT appears to be less specific for asbestos exposure.
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Affiliation(s)
- Giuseppe Mastrangelo
- Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy
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Ochsmann E, Carl T, Brand P, Raithel HJ, Kraus T. Inter-reader variability in chest radiography and HRCT for the early detection of asbestos-related lung and pleural abnormalities in a cohort of 636 asbestos-exposed subjects. Int Arch Occup Environ Health 2009; 83:39-46. [PMID: 19618201 DOI: 10.1007/s00420-009-0443-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 06/25/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare inter-reader variability of chest X-ray and high resolution computed tomography (HRCT) scans of formerly asbestos-exposed employees over a 4-year period. METHODS In this longitudinal study, 636 formerly asbestos-exposed persons were annually examined with chest radiographs and HRCT scans. Ten observer pairs classified the radiographs and HRCT scans, using the ILO classification and a custom-made CT classification. Inter-observer variability was calculated using the kappa-coefficient. RESULTS Despite all expectations, HRCT inter-reader variability according to asbestos-related lung or pleura alterations at an early stage did not turn out to be better than X-ray inter-reader variability. Substantial inter-observer agreement was found for pleural calcifications (kappa(X-ray) = 0.63; kappa(CT) = 0.64). Averaging over kappa led to fair inter-observer agreement of both methods (kappa(X-ray) = 0.36; kappa(CT) = 0.34). CONCLUSIONS High resolution computed tomography scans are superior to X-rays in detecting lung alterations after asbestos exposure and are supposedly easier to interpret. Nevertheless, inter-observer variability did not differ between the two methods in this study. This was probably due to the only discrete asbestos-related lung or pleura alterations of this cohort and to the unfamiliar CT classification sheet, which was revised on the basis of the presented results.
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Affiliation(s)
- Elke Ochsmann
- Institute of Occupational and Social Medicine, Medical Faculty, RWTH-Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
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Affiliation(s)
- Jeung Sook Kim
- Department of Radiology, Dongguk University College of Medicine, Korea. ,
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Ahn YS, Kim HR. Asbestosis Epidemics Caused by Non-occupational Neighborhood Exposure. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2009. [DOI: 10.5124/jkma.2009.52.5.472] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yeon-Soon Ahn
- Department of Occupational Medicine, Dongguk University College of Medicine, Korea.
| | - Hyoung-Ryoul Kim
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Korea.
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Horton K, Kapil V, Larson T, Muravov O, Melnikova N, Anderson B. A Review of the Federal Government's Health Activities in Response to Asbestos-Contaminated Ore Found in Libby, Montana. Inhal Toxicol 2008; 18:925-40. [PMID: 16920666 DOI: 10.1080/08958370600835161] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Vermiculite ore is a naturally occurring fibrous mineral widely used in various consumer products, such as attic insulation, lawn and garden products, and fireproofing material. While most vermiculite ore and products do not pose a health hazard, the vermiculite mined from Libby, MT was contaminated with naturally occurring asbestos. The federal Agency for Toxic Substances and Disease Registry (ATSDR) has documented a significant number of asbestos-related deaths among Libby residents. Additionally, as part of the ongoing investigation, ATSDR has learned that this contaminated ore was shipped to hundreds of locations around the United States for processing. While the Libby mine is now closed, studies from ATSDR and elsewhere show that people who worked in the Libby mine or vermiculite processing facilities may have been exposed to hazardous levels of asbestos while the facilities were in operation. People who lived or worked near these sites also may have been exposed to asbestos if they came into contact with contaminated vermiculite. Prolonged exposure to asbestos can cause serious and life-threatening health conditions, including asbestosis, lung cancer, and mesothelioma. In response, ATSDR has initiated 10 different activities to help evaluate the potential health effects among Libby residents and populations throughout the United States who might have been exposed to the asbestos-contaminated ore found in Montana. Some of these activities include conducting environmental exposure evaluations, health statistics reviews, community screenings, and disease-specific surveillance. This article presents the various follow-up activities that have been conducted to date by ATSDR and partnering state health departments.
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Affiliation(s)
- Kevin Horton
- Agency for Toxic Substances and Disease Registry, Division of Health Studies, Surveillance and Registries Branch, Atlanta, Georgia 30333, USA
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Miles SE, Sandrini A, Johnson AR, Yates DH. Clinical consequences of asbestos-related diffuse pleural thickening: A review. J Occup Med Toxicol 2008; 3:20. [PMID: 18775081 PMCID: PMC2553409 DOI: 10.1186/1745-6673-3-20] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 09/08/2008] [Indexed: 11/15/2022] Open
Abstract
Asbestos-related diffuse pleural thickening (DPT), or extensive fibrosis of the visceral pleura secondary to asbestos exposure, is increasingly common due to the large number of workers previously exposed to asbestos. It may coexist with asbestos related pleural plaques but has a distinctly different pathology. The pathogenesis of this condition as distinct from pleural plaques is gradually becoming understood. Generation of reactive oxygen and nitrogen species, profibrotic cytokines and growth factors in response to asbestos is likely to play a role in the formation of a fibrinous intrapleural matrix. Benign asbestos related pleural effusions commonly antedate the development of diffuse pleural thickening. Environmental as well as occupational exposure to asbestos may also result in pleural fibrosis, particularly in geographic areas with naturally occurring asbestiform soil minerals. Pleural disorders may also occur after household exposure. High resolution computed tomography (CT) is more sensitive and specific than chest radiography for the diagnosis of diffuse pleural thickening, and several classification systems for asbestos-related disorders have been devised. Magnetic resonance imaging and fluorodeoxyglucose positron emission tomography (PET) scanning may be useful in distinguishing between DPT and malignant mesothelioma. DPT may be associated with symptoms such as dyspnoea and chest pain. It causes a restrictive defect on lung function and may rarely result in respiratory failure and death. Treatment is primarily supportive.
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Affiliation(s)
- Susan E Miles
- Dust Diseases Board Research & Education Unit, Sydney, NSW, Australia.
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Paris C, Martin A, Letourneux M, Wild P. Modelling prevalence and incidence of fibrosis and pleural plaques in asbestos-exposed populations for screening and follow-up: a cross-sectional study. Environ Health 2008; 7:30. [PMID: 18570653 PMCID: PMC2441611 DOI: 10.1186/1476-069x-7-30] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 06/20/2008] [Indexed: 05/26/2023]
Abstract
BACKGROUND CT-Scan is currently under assessment for the screening of asbestos-related diseases. However, to date no consensus exists as to how to select high-risk asbestos-exposed populations suitable for such screening programs. The objective of this study is to select the most relevant exposure variables for the prediction of pleural plaques and asbestosis in order to guide clinicians in their use of CT-Scan. METHODS A screening program of non malignant asbestos-related diseases by CT-scan was conducted among asbestos-exposed volunteers in France. Precise assessments of asbestos exposure were obtained by occupational hygiene measurements and a job-exposure matrix. Several parameters were calculated (time since first exposure, duration, intensity and cumulative exposure to asbestos). Predictive parameters of prevalence and incidence were then estimated by standard logistic and a complementary log-log regression models. RESULTS 1011 subjects were recruited in this screening program among them 474 (46.9%) presented with pleural plaques and 61 (6.0%) with interstitial changes compatible with asbestosis on CT-scan. Time since first exposure (p < 0.0001) and either cumulative or mean exposure (p < 0.0001) showed independent associations with both pleural plaques and asbestosis prevalence and pleural plaques incidence. Modelling incidence of pleural plaques showed a 0.8% to 2.4% yearly increase for a mean exposure of 1 f/ml. CONCLUSION Our findings confirmed the role played by time since first exposure and dose but not duration in asbestos-related diseases. We recommend to include these parameters in high-risk populations suitable for screening of these diseases. Short-periodicity of survey of pleural plaques by CT-Scan seemed not to be warranted.
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Affiliation(s)
- Christophe Paris
- Inserm ERI-11, Assessment and prevention of occupational and environmental risks Medical School, 9 av de la Forêt de Haye – BP 184, 54505 Vandoeuvre-les-Nancy Cedex, France
- Nancy-University, 1 rue Lyautey, 54000 Nancy, France
| | - Aurélie Martin
- Inserm ERI-11, Assessment and prevention of occupational and environmental risks Medical School, 9 av de la Forêt de Haye – BP 184, 54505 Vandoeuvre-les-Nancy Cedex, France
| | - Marc Letourneux
- Occupational Diseases Department, University Hospital, Avenue de la cote de Nacre, 14000 CAEN, France
| | - Pascal Wild
- Département Epidémiologie en Entreprises, Rue du Morvan, CS 60027,54519 Vandoeuvre Les Nancy Cedex, France
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Beigelman-Aubry C, Ferretti G, Mompoint D, Ameille J, Letourneux M, Laurent F. Atlas iconographique tomodensitométrique des pathologies bénignes de l’amiante. ARCH MAL PROF ENVIRO 2008. [DOI: 10.1016/j.admp.2008.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Greillier L, Astoul P. Mesothelioma and Asbestos-Related Pleural Diseases. Respiration 2008; 76:1-15. [DOI: 10.1159/000127577] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
This chapter consists of a review of the literature regarding radiographic and tomographic characteristics of the principal occupational respiratory diseases (silicosis and asbestosis). Special attention is given to the practical relevance of high-resolution computed tomography, which is the most sensitive and specific method of identifying and quantifying the extent of pleural and parenchymal lesions related to such diseases.
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Beigelman-Aubry C, Ferretti G, Mompoint D, Ameille J, Letourneux M, Laurent F. Atlas iconographique tomodensitométrique des pathologies bénignes de l’amiante. Rev Mal Respir 2007; 24:759-81. [PMID: 17632435 DOI: 10.1016/s0761-8425(07)91150-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The demonstration by computed tomography of abnormalities related to asbestos is essential for the recognition of industrial disease, the compensation of which has considerable economic consequences. The use of computed tomography, the most reliable technique for the detection of pleuro-parenchymatous abnormalities related to asbestos exposure, has increased considerably in France since the publication of the results of a consensus conference in Paris in 1999. Since that time, developments in CT technology have noticeably modified the protocols of investigation and increased the sensitivity of the detection of pleural and interstitial parenchymatous abnormalities and of nodules. The technical recommendations and those for the interpretation of pleural and parenchymatous abnormalities need to be well known. They are presented in the form of an atlas that gives detailed criteria for asbestosis, pleural plaques and pleural fibrosis. The diagnosis of pleural plaques depends on the combination of clear limits at the pleural and pulmonary interface, typical topography and multiple, bilateral localization. In the context of asbestos exposure the plaques are characteristic of this exposure, unlike diffuse pleural thickening, crow's feet images, parenchymatous bands and entrapped atalectasis. The writing of the radiological report would be most appropriate on this basis.
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Affiliation(s)
- C Beigelman-Aubry
- Service de Radiologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France.
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Beigelman-Aubry C, Ferretti G, Mompoint D, Ameille J, Letourneux M, Frija J, Laurent F. Atlas iconographique tomodensitométrique des pathologies bénignes de l’amiante. ACTA ACUST UNITED AC 2007; 88:845-62. [PMID: 17652978 DOI: 10.1016/s0221-0363(07)89886-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The demonstration by computed tomography of abnormalities related to asbestos is essential for the recognition of industrial disease, the compensation of which has considerable economic consequences. The use of compute tomography, the most reliable technique for the detection of pleuro-parenchymatous abnormalities related to asbestos exposure, has increased considerably in France since the publication of the results of a consensus conference in Paris in 1999. Since that time, developments in technology have noticeably modified the protocols of investigation and increased the sensitivity of the detection of pleural and interstitial parenchymatous abnormalities and of nodules. The technical recommendations and those for the interpretation of pleural and parenchymatous abnormalities need to be well known. They are presented in the form of an atlas that gives detailed criteria for asbestosis, pleural plaques and pleural fibrosis. The diagnosis of pleural plaques depends on the combination of clear limits at the pleural and pulmonary interface, typical topography and multiple, bilateral localization. In the context of asbestos exposure the plaques are characteristic of this exposure, unlike diffuse pleural thickening, crow's feet images, parenchymatous bands and entrapped atalectasis. The writing of the radiological report would be most appropriate on this basis.
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Affiliation(s)
- C Beigelman-Aubry
- Service de Radiologie, Hôpital de la Pitié-Salpêtrière, AP-HP, 47-83 bd de l'Hôpital, 75651 Paris cedex 13.
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Ameille J, Descatha A. [Screening for benign pleural disease in adults: why and how?]. REVUE DE PNEUMOLOGIE CLINIQUE 2006; 62:89-92. [PMID: 16670661 DOI: 10.1016/s0761-8417(06)75421-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Benign diseases of the pleura are clearly dominated by asbestos-related conditions. It is important to distinguish diseases affecting the parietal pleura (pleural plaques) and those affecting the visceral pleura (pleurisy and diffuse thickening). The social benefits which could be obtained by identifying affected persons warrants screening in France, even more so than non-demonstrated medical benefits. Thoracic computed tomography without contrast is the examination of choice. A rigorous protocol is required for proper execution and interpretation.
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Affiliation(s)
- J Ameille
- Unité de Pathologie Professionnelle, de Santé au Travail et d'Insertion, Hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches.
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Meirelles GSP, Kavakama JI, Jasinowodolinski D, Nery LE, Terra-Filho M, Rodrigues RT, Neder JA, Napolis LM, Bagatin E, D'Ippolito G, Müller NL. Pleural Plaques in Asbestos-exposed Workers: Reproducibility of a New High-resolution CT Visual Semiquantitative Measurement Method. J Thorac Imaging 2006; 21:8-13. [PMID: 16538149 DOI: 10.1097/01.rti.0000191424.50208.bd] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the reproducibility of a new high-resolution computed tomography (CT) visual semiquantitative method for pleural plaques in asbestos-exposed workers. MATERIAL AND METHODS We performed thin-section CT in 752 chrysotile asbestos mining workers and ex-workers. Institutional review board approval and signed written informed consent from subjects were obtained. Two readers independently evaluated the 752 CT scans and identified 57 workers (mean age +/- SD, 61.8 years +/- 8.1; range, 37 to 81 years) who had pleural plaques and no other pleural or parenchymal abnormality. Three independent radiologists then quantified the plaque burden in these 57 workers using a scoring system based on the evaluation of the maximum thickness of parietal pleural plaques and percentage of parietal pleural surface involvement. We also calculated the proportion between the number of CT slices with diaphragmatic plaques and the total number of slices in which the diaphragm was seen (pdiaph). The intraobserver and interobserver agreements were analyzed using weighted Kappa coefficient. RESULTS Interobserver agreements were good for the pleural plaque score (k = 0.61, 0.75, and 0.79) and ranged from good (k = 0.61) to excellent (k = 0.86) for the pdiaph. Intraobserver agreements ranged from good to excellent for the pleural plaque score (k = 0.79 and 1.00) and for the pdiaph (k = 0.79 and 0.93). CONCLUSION The method proposed for high-resolution CT pleural plaque quantification in asbestos-exposed workers has a high reproducibility.
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Affiliation(s)
- Gustavo Souza Portes Meirelles
- Department of Radiology, Federal University of São Paulo, Rua Napoleão de Barros, 800, Vila Clementino, 04023-900, Brazil
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Murlidhar V, Kanhere V. Asbestosis in an asbestos composite mill at Mumbai: a prevalence study. Environ Health 2005; 4:24. [PMID: 16262892 PMCID: PMC1289287 DOI: 10.1186/1476-069x-4-24] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 10/31/2005] [Indexed: 05/05/2023]
Abstract
BACKGROUND Of an estimated 100,000 workers exposed to asbestos in India, less than 30 have been compensated. The reasons for such a small number are: refusal by management sponsored studies to grant medical certifications to workers suffering from occupational diseases, lack of training for doctors in diagnosis of occupational lung diseases, deliberate misdiagnosis by doctors of asbestosis as either chronic bronchitis or tuberculosis and the inherent class bias of middle class doctors against workers. The aim of the study was to identify workers suffering from Asbestosis (parenchymal and pleural non-malignant disease) among the permanent workers of the Hindustan Composites Factory and assess their disability and medically certify them, whereupon they could avail of their basic rights to obtain compensation and proper treatment. METHODS The study was conducted by the Occupational Health and Safety Centre and the Workers' Union. Asbestosis was diagnosed if they had an occupational history of asbestos exposure for at least 15 years and showed typical radiographic findings. RESULTS Of 232 workers in the factory, 181 participated in the survey. 22% of them had asbestosis. All the asbestos affected workers had at least 20 years of exposure. 7% had rhonchi, 34% had late basal inspiratory rates, 82% had more than 80% of Forced Expiratory Volume in the first second (FEV1)/Forced Vital capacity (FVC) ratio and 66% had FVC less than 80% of the predicted value. On radiology 7% had only pleural disease, 10% had both pleural and parenchymal disease and 82% had only parenchymal disease. The association of pleural disease with chest pain was statistically significant. CONCLUSION We found the prevalence of asbestosis among exposed workers to be less than that anticipated for the number of years of exposure due to "Healthy Worker Effect". We suggest that all affected asbestos workers (including those who have been forced to leave) in India be medically certified and compensated. We also recommend better control of asbestos use in India. We also implore the management to provide all information about the work process and its hazards, conduct medical checkups as mandated by law and give the medical records to the workers.
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Affiliation(s)
- V Murlidhar
- Department of Surgery, LTM Medical College, 1Floor, College building, Sion, Mumbai 400 022, India
| | - Vijay Kanhere
- Occupational Health and Safety Centre, Gokuldas Pasta Road, Neelkant Apts, Dadar (E), Mumbai 400 014, India
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Gotway MB, Reddy GP, Webb WR, Elicker BM, Leung JWT. High-resolution CT of the lung: patterns of disease and differential diagnoses. Radiol Clin North Am 2005; 43:513-42, viii. [PMID: 15847814 DOI: 10.1016/j.rcl.2005.01.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
High-resolution CT (HRCT) of the lung is a powerful tool for the investigation of patients with acute or chronic respiratory symptoms or diffuse parenchymal lung disease. Detailed knowledge of normal pulmonary anatomy and an understanding of how normal anatomy is altered in disease states are required to appreciate fully HRCT findings in patients with pulmonary disease. Detailed knowledge of the technical aspects of HRCT examinations is required for optimal image quality. With the proper foundation, a pattern approach to HRCT interpretation may then be used successfully to provide accurate and reproducible interpretation.
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Affiliation(s)
- Michael B Gotway
- Department of Radiology, San Francisco General Hospital, University of California at San Francisco, 1001 Potrero Avenue, Room 1X 55, Box 1325, San Francisco, CA 94110, USA.
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Diette GB, Scatarige JC, Haponik EF, Merriman B, Fishman EK. Do High-Resolution CT Findings of Usual Interstitial Pneumonitis Obviate Lung Biopsy? Respiration 2005; 72:134-41. [PMID: 15824522 DOI: 10.1159/000084043] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2004] [Accepted: 07/29/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High-resolution CT (HRCT) of the lungs has become an essential component to evaluate patients with diffuse lung disease. Little is known, however, about the current practices of pulmonologists caring for patients with these complex conditions, and, in particular, whether HRCT can obviate the need for surgical lung biopsy. OBJECTIVES To investigate the practices of pulmonologists concerning the acceptability of a HRCT diagnosis in lieu of lung biopsy in diffuse lung disease. METHODS We asked practicing pulmonologists among membership of the American College of Chest Physicians whether HRCT results could replace lung biopsy in 16 diffuse lung diseases. Responses were examined in light of published evidence, practice guidelines, and certain practice parameters. RESULTS Two hundred and thirty (52.6%) of 437 eligible physicians responded. Sixty-seven percent (67%) of respondents accepted HRCT diagnosis for idiopathic pulmonary fibrosis/usual interstitial pneumonia (IPF/UIP) despite their awareness of guidelines recommending histological diagnosis. Most would not accept a radiologic diagnosis for lymphangioleiomyomatosis (LAM; 37%) or eosinophilic granuloma (Langerhans' cell histiocytosis, LCH; 19%), even though CT findings are frequently characteristic. Responses were similar by type of clinical practice and recency of fellowship training. Chest physicians who referred patients for HRCT more frequently were more likely to accept HRCT diagnosis (p=0.008) and those who had higher self-ratings of proficiency in reading HRCT (p = 0.004) were more likely to believe HRCT often suggests specific diagnosis. CONCLUSIONS Most US pulmonologists will accept an HRCT diagnosis of IPF/UIP without lung biopsy, but are reluctant to do so for most other diffuse lung conditions including LAM and LCH.
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Affiliation(s)
- Gregory B Diette
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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