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Lee GM, Walker CM. Pleural Thickening: Detection, Characterization, and Differential Diagnosis. Semin Roentgenol 2023; 58:399-410. [PMID: 37973269 DOI: 10.1053/j.ro.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Gregory M Lee
- Department of Radiology, Division of Cardiothoracic Imaging, University of Kansas Medical Center, Kansas City, KS
| | - Christopher M Walker
- Department of Radiology, Division of Cardiothoracic Imaging, University of Kansas Medical Center, Kansas City, KS.
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Kumari S, Jaseemudheen M. Assessment of Pleural Effusion by Means of Imaging Modalities. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1757446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPleural effusion is the fluid collection in the pleural cavity between the parietal and visceral pleura. It is caused by parenchymal diseases such as inflammatory disorders or infection. Pleural effusion can be diagnosed using imaging modalities such as X-ray, computed tomography (CT) scan, ultrasound, and magnetic resonance imaging (MRI).MRI is rarely performed to investigate pleural effusion due to motion artifacts and has a poor spatial resolution. Benign and malignant pleural effusion can be diagnosed using an X-ray, CT scan, or ultrasound. Pleural effusion volume can be measured by using ultrasound. This article reviews the feasibility of investigating pleural effusion and fluid drainage in medical imaging and compares to find the best modality for its diagnosis.
Description: This article reports the possible options to detect pleural effusion in medical imaging and compares them to find the best modality for its diagnosis.
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Affiliation(s)
- Swati Kumari
- Department of Radiodiagnosis and Imaging, KS Hegde Medical Academy (KSHEMA), Nitte (Deemed to be University), Mangalore, India
| | - M.M. Jaseemudheen
- Department of Radiodiagnosis and Imaging, KS Hegde Medical Academy (KSHEMA), Nitte (Deemed to be University), Mangalore, India
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3
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Affiliation(s)
- Maria Tsakok
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford OX3 7LE, UK
| | - Rob Hallifax
- Department of Respiratory Medicine, University of Oxford, Churchill Hospital, Old Road, Oxford OX3 7LE, UK.
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Chatterjee A, Sen Dutt T, Ghosh P, Mukhopadhyay S, Chandra A, Sen S. Inflammatory Lesions Mimicking Chest Malignancy: CT, Bronchoscopy, EBUS, and PET Evaluation From an Oncology Referral Center. Curr Probl Diagn Radiol 2021; 51:235-249. [PMID: 33483189 DOI: 10.1067/j.cpradiol.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/19/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022]
Abstract
Infective and inflammatory diseases can mimic malignancy of the lung. Granulomatous inflammations are common causes of pulmonary nodule, mass, or nodal disease. Systemic infection or inflammation also commonly involves the lung that may raise suspicion of a malignant process. Even in patients with a known malignancy, inflammatory diseases can simulate new metastasis or disease progression. Knowledge of the imaging features of these diseases is essential to prevent missed or overdiagnosis of malignancy. Radiologists also need to be familiar with the scope and limitations of bronchoscopy, endobronchial ultrasound, PET-CT, and biopsy to guide clinical management. In this review, we discuss the imaging features and diagnostic approach of common mimickers of chest malignancy that involve the chest wall, pleura, lung parenchyma, and mediastinal nodes.
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Affiliation(s)
- Argha Chatterjee
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India.
| | - Tiyas Sen Dutt
- Department of Pulmonology, Tata Medical Center, Kolkata, West Bengal, India
| | - Priya Ghosh
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | - Sumit Mukhopadhyay
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | - Aditi Chandra
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | - Saugata Sen
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
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Harris EJA, Musk A, de Klerk N, Reid A, Franklin P, Brims FJH. Diagnosis of asbestos-related lung diseases. Expert Rev Respir Med 2019; 13:241-249. [DOI: 10.1080/17476348.2019.1568875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Edward J. A. Harris
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Arthur Musk
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Nicholas de Klerk
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Alison Reid
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Peter Franklin
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Fraser J. H. Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
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6
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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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7
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de Fonseka D, Edey A, Stadon L, Viner J, Darby M, Maskell NA. The physiological consequences of different distributions of diffuse pleural thickening on CT imaging. Br J Radiol 2017; 90:20170218. [PMID: 28707542 DOI: 10.1259/bjr.20170218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Diffuse pleural thickening (DPT) refers to extensive visceral pleural fibrosis with adhesion formation to the parietal pleura obliterating the pleural space. The radiological definition of DPT remains controversial with most of the literature requiring the presence of an obliterated costophrenic angle (CPA) for defining DPT. We conducted a study to investigate the variable distributions of DPT and associated lung function deficit. METHODS 85 patients referred to a pleural clinic with suspected pleural thickening were screened for our study. Data were collected from 37 patients with DPT confirmed on CT by size criteria (≥3 mm thick, ≥5 cm wide and ≥8 cm in length), and 21 controls with pleural plaques but no other pleuroparenchymal pathology. 27 patients were excluded. Groups were matched to age, body mass index and smoking history. RESULTS The percentage of predicted forced vital capacity showed a gradual decline from 98.9% for the control group to 83.5% in the DPT without CPA obliteration group (p < 0.05), to 79.5% in the unilateral DPT group (p < 0.001) and 66.7% in the bilateral group (p < 0.001). Similar reductions were seen in the percentage of predicted total lung capacity in the DPT with no CPA obliteration group and the bilateral DPT group. CONCLUSION Our study shows an incremental reduction in the forced vital capacity and total lung capacity in DPT without CPA obliteration, unilateral and bilateral DPT when compared with a matched control group. Advances in knowledge: Different distributions of DPT including no CPA obliteration can cause respiratory impairment, with bilateral DPT being the worst affected.
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Affiliation(s)
| | - Anthony Edey
- 2 Radiology Department, North Bristol NHS Trust, Southmead Hospital , Bristol , UK
| | - Louise Stadon
- 3 Academic Respiratory Unit, North Bristol NHS Trust , Bristol , UK
| | - Jason Viner
- 4 Respiratory Physiology, North Bristol NHS Trust , Bristol , UK
| | - Michael Darby
- 2 Radiology Department, North Bristol NHS Trust, Southmead Hospital , Bristol , UK
| | - Nick A Maskell
- 1 Academic Respiratory Unit, University of Bristol , Bristol , UK
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Optical coherence tomography-based contact indentation for diaphragm mechanics in a mouse model of transforming growth factor alpha induced lung disease. Sci Rep 2017; 7:1517. [PMID: 28473708 PMCID: PMC5431417 DOI: 10.1038/s41598-017-01431-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/30/2017] [Indexed: 01/25/2023] Open
Abstract
This study tested the utility of optical coherence tomography (OCT)-based indentation to assess mechanical properties of respiratory tissues in disease. Using OCT-based indentation, the elastic modulus of mouse diaphragm was measured from changes in diaphragm thickness in response to an applied force provided by an indenter. We used a transgenic mouse model of chronic lung disease induced by the overexpression of transforming growth factor-alpha (TGF-α), established by the presence of pleural and peribronchial fibrosis and impaired lung mechanics determined by the forced oscillation technique and plethysmography. Diaphragm elastic modulus assessed by OCT-based indentation was reduced by TGF-α at both left and right lateral locations (p < 0.05). Diaphragm elastic modulus at left and right lateral locations were correlated within mice (r = 0.67, p < 0.01) suggesting that measurements were representative of tissue beyond the indenter field. Co-localised images of diaphragm after TGF-α overexpression revealed a layered fibrotic appearance. Maximum diaphragm force in conventional organ bath studies was also reduced by TGF-α overexpression (p < 0.01). Results show that OCT-based indentation provided clear delineation of diseased diaphragm, and together with organ bath assessment, provides new evidence suggesting that TGF-α overexpression produces impairment in diaphragm function and, therefore, an increase in the work of breathing in chronic lung disease.
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Hallifax RJ, Talwar A, Wrightson JM, Edey A, Gleeson FV. State-of-the-art: Radiological investigation of pleural disease. Respir Med 2017; 124:88-99. [PMID: 28233652 DOI: 10.1016/j.rmed.2017.02.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/12/2017] [Accepted: 02/13/2017] [Indexed: 12/17/2022]
Abstract
Pleural disease is common. Radiological investigation of pleural effusion, thickening, masses, and pneumothorax is key in diagnosing and determining management. Conventional chest radiograph (CXR) remains as the initial investigation of choice for patients with suspected pleural disease. When abnormalities are detected, thoracic ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) can each play important roles in further investigation, but appropriate modality selection is critical. US adds significant value in the identification of pleural fluid and pleural nodularity, guiding pleural procedures and, increasingly, as "point of care" assessment for pneumothorax, but is highly operator dependent. CT scan is the modality of choice for further assessment of pleural disease: Characterising pleural thickening, some pleural effusions and demonstration of homogeneity of pleural masses and areas of fatty attenuation or calcification. MRI has specific utility for soft tissue abnormalities and may have a role for younger patients requiring follow-up serial imaging. MRI and PET/CT may provide additional information in malignant pleural disease regarding prognosis and response to therapy. This article summarises existing techniques, highlighting the benefits and applications of these different imaging modalities and provides an up to date review of the evidence.
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Affiliation(s)
- R J Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford, UK.
| | - A Talwar
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford, UK
| | - J M Wrightson
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford, UK
| | - A Edey
- Department of Radiology, North Bristol NHS Trust, Bristol, UK
| | - F V Gleeson
- Department of Radiology, Churchill Hospital, Old Road, Oxford, UK
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Abstract
Occupational lung diseases span a variety of pulmonary disorders caused by inhalation of dusts or chemical antigens in a vocational setting. Included in these are the classic mineral pneumoconioses of silicosis, coal worker's pneumoconiosis, and asbestos-related diseases as well as many immune-mediated and airway-centric diseases, and new and emerging disorders. Although some of these have characteristic imaging appearances, a multidisciplinary approach with focus on occupational exposure history is essential to proper diagnosis.
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Affiliation(s)
- Jay Champlin
- Department of Radiology, 1959 Northeast Pacific Street, RR 215, Box 357115, Seattle, WA 98195, USA.
| | - Rachael Edwards
- Department of Radiology, 1959 Northeast Pacific Street, RR 215, Box 357115, Seattle, WA 98195, USA
| | - Sudhakar Pipavath
- Department of Radiology, 1959 Northeast Pacific Street, RR 215, Box 357115, Seattle, WA 98195, USA
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11
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Maxim LD, Niebo R, Utell MJ. Are pleural plaques an appropriate endpoint for risk analyses? Inhal Toxicol 2015; 27:321-34. [DOI: 10.3109/08958378.2015.1051640] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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HRCT/CT and Associated Spirometric Effects of Low Libby Amphibole Asbestos Exposure. J Occup Environ Med 2015; 57:6-13. [DOI: 10.1097/jom.0000000000000373] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Abstract
Context US EPA proposed a Reference Concentration for Libby amphibole asbestos based on the premise that pleural plaques are adverse and cause lung function deficits. Objective We conducted a systematic review to evaluate whether there is an association between pleural plaques and lung function and ascertain whether results were dependent on the method used to identify plaques. Methods Using the PubMed database, we identified studies that evaluated pleural plaques and lung function. We assessed each study for quality, then integrated evidence and assessed associations based on the Bradford Hill guidelines. We also compared the results of HRCT studies to those of X-ray studies. Results We identified 16 HRCT and 36 X-ray studies. We rated six HRCT and 16 X-ray studies as higher quality based on a risk-of-bias analysis. Half of the higher quality studies reported small but statistically significant mean lung function decrements associated with plaques. None of the differences were clinically significant. Many studies had limitations, such as inappropriate controls and/or insufficient adjustment for confounders. There was little consistency in the direction of effect for the most commonly reported measurements. X-ray results were more variable than HRCT results. Pleural plaques were not associated with changes in lung function over time in longitudinal studies. Conclusion The weight of evidence indicates that pleural plaques do not impact lung function. Observed associations are most likely due to unidentified abnormalities or other factors.
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Laurent F, Paris C, Ferretti GR, Beigelman C, Montaudon M, Latrabe V, Jankowski A, Badachi Y, Clin B, Gislard A, Letourneux M, Luc A, Schorlé E, Brochard P, Ameille J, Pairon JC. Inter-reader agreement in HRCT detection of pleural plaques and asbestosis in participants with previous occupational exposure to asbestos. Occup Environ Med 2014; 71:865-70. [PMID: 25286915 DOI: 10.1136/oemed-2014-102336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate inter-reader agreement for the detection of pleural and parenchymal abnormalities using CT in a large cross-sectional study comprising information on individual cumulative exposure to asbestos. METHODS The project was approved by the hospital ethics committee, and all patients received information on the study and gave their written informed consent. In 5511 CT scans performed in a cohort of retired workers previously exposed to asbestos and volunteering to participate in a multiregional survey programme (Asbestos Related Diseases Cohort, ARDCO), double randomised standardised readings, triple in case of disagreement, were performed by seven trained expert radiologists specialised in thoracic imaging and blind to the initial interpretation. Inter-reader agreement was evaluated by calculating the κ-weighted coefficient between pairs of expert readers and results of routine practice and final diagnosis after expert reading. RESULTS κ-Weighted coefficients between trained experts ranged from 0.28 to 0.52 (fair to good), 0.59 to 0.86 (good to excellent) and 0.11 to 0.66 (poor to good) for the diagnosis of asbestosis, pleural plaques and fibrosis of the visceral pleura, respectively. κ-Weighted coefficients between results of routine practice and final diagnosis after expert reading were 0.13 (poor), 0.53 (moderate) and 0.11 (poor) for the diagnosis of asbestosis, pleural plaques and fibrosis of the visceral pleura, respectively. CONCLUSIONS Interpretation of benign asbestos-related thoracic abnormalities requires standardisation of the reading and trained readers, particularly for participants asking for compensation, and with a view to the longitudinal survey of asbestos-exposed workers.
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Affiliation(s)
- François Laurent
- Centre Cardiothoracique INSERM 1045, France Université de Bordeaux and CHU de Bordeaux, France
| | - Christophe Paris
- EA7298 Université de Lorraine, France Faculté de Médecine, and CHU Nancy, France
| | - Gilbert R Ferretti
- INSERM U823, and Université J Fourrier, and Clinique universitaire de radiologie et imagerie médicale, CHU, Grenoble, France
| | - Catherine Beigelman
- Service de Radiologie Asssistance-Publique Hôpitaux de Paris, 47-83 Boulevard de l'hôpital, Paris, France
| | - Michel Montaudon
- Centre Cardiothoracique INSERM 1045, France Université de Bordeaux and CHU de Bordeaux, France
| | - Valerie Latrabe
- Centre Cardiothoracique INSERM 1045, France Université de Bordeaux and CHU de Bordeaux, France
| | - A Jankowski
- INSERM U823, and Université J Fourrier, and Clinique universitaire de radiologie et imagerie médicale, CHU, Grenoble, France
| | - Yasmina Badachi
- Service de Radiologie Asssistance-Publique Hôpitaux de Paris, 47-83 Boulevard de l'hôpital, Paris, France
| | - Bénédicte Clin
- Cancers et Populations INSERM U1086, France Service de Santé au Travail et Pathologie Professionnelle, Faculté de Médecine and CHU de Caen, France
| | | | - Marc Letourneux
- Cancers et Populations INSERM U1086, France Service de Santé au Travail et Pathologie Professionnelle, Faculté de Médecine and CHU de Caen, France
| | | | | | | | - Jacques Ameille
- Unité de Pathologie Professionnelle, Assistance-Publique Hôpitaux de Paris, Hôpital Raymond Poincaré, Garches, France Institut Interuniversitaire de Médecine du Travail de Paris-Ile de France, Paris, France
| | - Jean-Claude Pairon
- Institut Interuniversitaire de Médecine du Travail de Paris-Ile de France, Paris, France Service de Pneumologie et Pathologie Professionnelle, INSERM, U955 and Université Paris-Est Créteil, and Centre Hospitalier Intercommunal, Créteil, France
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15
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Clark KA, Flynn JJ, Goodman JE, Zu K, Karmaus WJ, Mohr LC. Pleural Plaques and Their Effect on Lung Function in Libby Vermiculite Miners. Chest 2014; 146:786-794. [DOI: 10.1378/chest.14-0043] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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16
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Moolgavkar SH, Anderson EL, Chang ET, Lau EC, Turnham P, Hoel DG. A review and critique of U.S. EPA's risk assessments for asbestos. Crit Rev Toxicol 2014; 44:499-522. [DOI: 10.3109/10408444.2014.902423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Affiliation(s)
- Jitesh Ahuja
- Department of Radiology, University of Washington, Seattle, WA
| | - Jeffrey P Kanne
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI.
| | - Cristopher A Meyer
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
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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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Walker CM, Takasugi JE, Chung JH, Reddy GP, Done SL, Pipavath SN, Schmidt RA, Godwin JD. Tumorlike Conditions of the Pleura. Radiographics 2012; 32:971-85. [DOI: 10.1148/rg.324115184] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Ferretti G. [What are the tools for post-occupational follow-up, how should they be performed and what are their performance, limits and benefit/risk ratio? Chest X-Ray and CT scan]. Rev Mal Respir 2011; 28:761-72. [PMID: 21742237 DOI: 10.1016/j.rmr.2011.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 02/17/2011] [Indexed: 10/18/2022]
Abstract
Chest radiography and computed tomography (CT) are the two radiological techniques used for the follow-up of people exposed to asbestos. Since the last conference of consensus (1999), the scientific literature has primarily covered high-resolution CT and high-resolution volume CT (HR-VCT). We consider in turn the contribution of digital thoracic radiography, recommendations for the performance of HR-VCT to ensure the quality of examination while controlling the delivered radiation dose, and the need to refer to the "CT atlas of benign diseases related to asbestos exposure", published by a group of French experts in 2007, for interpretation. The results of the published studies concerning radiography or CT are then reviewed. We note the great interobserver variability in the recognition of pleural plaques and asbestosis, indicating the need for adequate training of radiologists, and the importance of defining standardized, quantified criteria for CT abnormalities. The very low agreement between thoracic and general radiologists must be taken into account. The reading of CT scans in cases of occupational exposure to asbestos should be entrusted to thoracic radiologists or to general radiologists having validated specific training. A double interpretation of CT could be considered in medicosocial requests. CT is more sensitive than chest radiography in the detection of bronchial carcinoma but generates a great number of false positive results (96 to 99%). No scientific data are available to assess the role of imaging by either CT or chest radiography in the early detection of mesothelioma.
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Affiliation(s)
- G Ferretti
- Université J-Fourrier, BP 53, 38041 Grenoble cedex 9, France.
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21
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Ferretti G. [Exposure to asbestos : radiography and chest CT]. JOURNAL DE RADIOLOGIE 2011; 92:450-60. [PMID: 21621114 DOI: 10.1016/j.jradio.2011.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 03/31/2011] [Indexed: 12/21/2022]
Affiliation(s)
- G Ferretti
- Université J.-Fourrier, Grenoble, France.
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22
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Park EK, Thomas PS, Wilson D, Choi HJ, Johnson AR, Yates DH. Chest pain in asbestos and silica-exposed workers. Occup Med (Lond) 2011; 61:178-83. [DOI: 10.1093/occmed/kqr011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Utell MJ, Maxim LD. Refractory ceramic fiber (RCF) toxicity and epidemiology: a review. Inhal Toxicol 2010; 22:500-21. [PMID: 20388033 DOI: 10.3109/08958370903521224] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper provides a review of the relevant literature on refractory ceramic fibers (RCFs), summarizing relevant data and information on the manufacture, processing, applications, potential occupational exposure, toxicology, epidemiology, risk analysis, and risk management. RCFs are amorphous fibers used for high-temperature insulation applications. RCFs are less durable/biopersistent than amphibole asbestos, but more durable/biopersistent than many other synthetic vitreous fibers (SVFs). Moreover, as produced/used, some RCFs are respirable. Toxicology studies with rodents using various exposure methods have shown that RCFs can cause fibrosis, lung cancer, and mesothelioma. Interpretation of these animal studies is difficult for various reasons (e.g., overload in chronic inhalation bioassays). Epidemiological studies of occupationally exposed cohorts in Europe and the United States have demonstrated measurable effects (e.g., mild respiratory symptoms and pleural plaques) but no disease (i.e., no interstitial fibrosis, no excess lung cancer, and no mesothelioma) to date. The RCF industry, working cooperatively with various government agencies in the United States, has developed a comprehensive product stewardship program (PSP) to identify and control risks associated with occupational exposure. One provision of the PSP is the adoption of a voluntary recommended exposure guideline (REG) of 0.5 fibers/milliliter (f/ml). Selected on the basis of prudence and demonstrated feasibility, compliance with the REG should reduce risks to levels between 0.073/1000 and 1.2/1000, based on extrapolations from chronic animal inhalation studies.
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Affiliation(s)
- Mark J Utell
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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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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Screening for Malignant Pleural Mesothelioma and Lung Cancer in Individuals with a History of Asbestos Exposure. J Thorac Oncol 2009; 4:620-8. [DOI: 10.1097/jto.0b013e31819f2e0e] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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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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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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Copley SJ, Lee YCG, Hansell DM, Sivakumaran P, Rubens MB, Newman Taylor AJ, Rudd RM, Musk AW, Wells AU. Asbestos-induced and smoking-related disease: apportioning pulmonary function deficit by using thin-section CT. Radiology 2006; 242:258-66. [PMID: 17090711 DOI: 10.1148/radiol.2421051167] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To retrospectively correlate the extent of individual diseases seen at thin-section computed tomography (CT) with pulmonary function in an initial group of patients with asbestos-related parenchymal disease (asbestosis) and to test these findings in a subsequent group of patients whose CT scans were retrospectively identified. MATERIALS AND METHODS This retrospective study had Institutional Review Board approval; informed consent was not required. The study included 133 individuals who had been exposed to asbestos. In the initial study group (81 patients; 79 men, two women; median age, 67 years), two observers used a CT scoring system to quantify the extent of pulmonary fibrosis, diffuse pleural thickening, small-airways disease, and emphysema. Multivariate equations were formulated by using independent CT variables to predict changes in total lung capacity (TLC) and carbon monoxide diffusing capacity (Dlco). The validity of these equations was then tested in a subsequent group of patients (52 patients; all men; median age, 60 years). RESULTS At thin-section CT, the extent of asbestos-induced pleuropulmonary disease and emphysema correlated significantly with physiologic impairment (P<.001). Combined CT variables predicted 58% and 57% of the variability in TLC and Dlco, respectively, despite considerable variation in the proportion of coexisting pathologic conditions. When predictive equations with CT variables derived from the initial study group were applied to the subsequent study group, predicted TLC (rho=0.75, P<.001) and Dlco (rho=0.64, P<.001) correlated strongly with measured values. CONCLUSION The proposed CT system provides a semiquantitative method for assessing the relative contribution of asbestos-induced pleuropulmonary disease and smoking-related emphysema to functional impairment.
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Affiliation(s)
- Susan J Copley
- Department of Radiology, Hammersmith Hospital, and Center for Respiratory Research, University College London, London, England
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Abstract
Imaging plays an important role in the diagnosis and subsequent management of patients with pleural disease. The presence of a pleural abnormality is usually suggested following a routine chest x-ray, with a number of imaging modalities available for further characterization. This article describes the radiographic and cross-sectional appearances of pleural diseases, which are commonly encountered in every day practice. The conditions covered include benign and malignant pleural thickening, pleural effusions, empyema and pneumothoraces. The relative merits of CT, MRI and PET in the assessment of these conditions and the role of image-guided intervention are discussed.
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Affiliation(s)
- Nagmi R Qureshi
- Department of Radiology, Churchill Hospital, Headington, Oxford OX3 7LJ, UK.
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33
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Gevenois P. Imagerie des pathologies bénignes de l’amiante. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)71565-0] [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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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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Meirelles GSP, Kavakama JI, Jasinowodolinski D, Nery LE, Terra-Filho M, Rodrigues RT, Neder JA, Bagatin E, D'ippolito G. Placas pleurais relacionadas com o asbesto: Revisão da literatura. REVISTA PORTUGUESA DE PNEUMOLOGIA 2005; 11:487-97. [PMID: 16288347 DOI: 10.1016/s0873-2159(15)30521-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Pleural plaques (PP) are considered to be hallmarks of asbestos exposure. They constitute focal thickenings of the pleura and are commonly seen in patients without lung disease. They can involve parietal, diaphragmatic and mediastinal pleura. Chest x-ray is frequently used for PP diagnosis, but computed tomography, especially when used the high-resolution technique, is the imaging exam with the greatest sensibility and specificity. PP are almost always asymptomatic, but there are some controversial about their relationship with asbestos exposure indexes, pulmonary functional alterations and risk of neoplasias.
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Affiliation(s)
- G S P Meirelles
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil.
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Abstract
Diseases of the pleura and pleural space are common and present a significant contribution to the workload of the chest radiologist. The radiology department plays a crucial role in the imaging and management of pleural disease. This review aims to describe and illustrate the appearances of common pleural pathologies on various radiological modalities including plain film, ultrasound, CT, magnetic resonance imaging and positron emission tomography. The review will also address the state-of-the-art techniques used to image pleural disease and discuss image-guided intervention in the management of pleural disease.
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Affiliation(s)
- Amlyn L Evans
- Department of Radiology, Churchill Hospital, Oxford Radcliffe Hospitals, Oxford, UK
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Sette A, Neder JA, Nery LE, Kavakama J, Rodrigues RT, Terra-Filho M, Guimarães S, Bagatin E, Müller N. Thin-Section CT Abnormalities and Pulmonary Gas Exchange Impairment in Workers Exposed to Asbestos. Radiology 2004; 232:66-74. [PMID: 15220494 DOI: 10.1148/radiol.2321030392] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the relationship between abnormalities at thin-section computed tomography (CT) and indexes of pulmonary gas exchange impairment at rest and during moderate exercise in workers exposed to asbestos. MATERIALS AND METHODS Eighty-two workers with long-term exposure to asbestos and abnormal thin-section CT findings underwent respiratory physiologic measurements at rest (lung diffusing capacity, Dlco) and during exercise (oxygen uptake-corrected alveolar-arterial pressure difference for oxygen, DeltaP[A-a]O(2)/VO(2)). CT results were compared with physiologic measurements of impairment in gas exchange (Dlco < 70% predicted value and/or DeltaP[A-a]O(2)/VO(2) > 20 mm Hg. L. min(-1)). The CT findings were divided into five categories by using a previously described method. Odds ratios and 95% CIs for gas exchange defects were calculated for patients grouped according to CT findings. Logistic regression analysis was performed with gas exchange as the dependent response and CT abnormalities as independent variables. RESULTS A significant association was found between extent of disease at CT and impairment of gas exchange (P <.01). Probability of functional impairment was increased with multifocal (class II) and diffuse (class III) CT abnormalities, particularly when several lesion types were found concomitantly. Logistic regression analysis demonstrated significant association of parenchymal bands (odds ratio, 6.20; 95% CI: 1.99, 19.22) and subpleural nodules (odds ratio, 3.83; 95% CI: 1.23, 11.89) with functional impairment. Presence and number of pleural plaques did not improve model accuracy for gas exchange impairment prediction (P >.05). CONCLUSION Thin-section CT grading of interstitial lung disease is useful in assessing the likelihood of pulmonary gas exchange impairment at rest (Dlco) and during exercise (DeltaP[A-a]O(2)/VO(2)) in workers with long-term asbestos exposure.
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Affiliation(s)
- Andrea Sette
- Pulmonary Function and Clinical Exercise Physiology Unit, Div of Respiratory Diseases, Federal Univ of São Paulo, Rua Professor Francisco de Castro 54, Vila Clementino, CEP 04020-050 São Paulo, Brazil
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Affiliation(s)
- David W Cugell
- Feinberg School of Medicine, Division of Respiratory and Critical Care Medicine, Northwestern University and The Veterans Administration Chicago Health Care System, Lakeside Division, Chicago, IL, USA.
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Copley SJ, Wells AU, Sivakumaran P, Rubens MB, Lee YCG, Desai SR, MacDonald SLS, Thompson RI, Colby TV, Nicholson AG, du Bois RM, Musk AW, Hansell DM. Asbestosis and idiopathic pulmonary fibrosis: comparison of thin-section CT features. Radiology 2003; 229:731-6. [PMID: 14576443 DOI: 10.1148/radiol.2293020668] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To identify differences, if any, in thin-section computed tomographic (CT) features between asbestosis and idiopathic pulmonary fibrosis (IPF) and to test the findings in a subset of histopathologically proved cases of usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP). MATERIALS AND METHODS Consecutive patients with a diagnosis of IPF (n = 212) or asbestosis (n = 74) were included. The relationships derived from the initial comparison were tested in a separate group of biopsy-proved UIP (n = 30) and NSIP (n = 23) cases. Two observers independently scored thin-section CT images for extent, distribution, and coarseness of fibrosis; proportion of ground-glass opacification; severity of traction bronchiectasis; and extent of emphysema. RESULTS After controlling for extent of fibrosis, patients with asbestosis had coarser fibrosis than those with IPF (odds ratio, 1.52; 95% CI: 1.25, 1.84; P <.001). Compared with the biopsy-proved cases, the asbestosis cases involved coarser fibrosis (after controlling for disease extent) than the NSIP cases (odds ratio, 2.48; 95% CI: 1.49, 4.11; P <.001) but fibrosis similar to that in the UIP cases. A basal and subpleural distribution of disease was usual in all subgroups but significantly more prevalent (P, <.01 to.001) with asbestosis than with UIP or NSIP. CONCLUSION The thin-section CT pattern of asbestosis closely resembles that of biopsy-proved UIP and differs markedly from that of biopsy-proved NSIP.
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Affiliation(s)
- Susan J Copley
- Department of Radiology, Hammersmith Hospital, London, England
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Abstract
The global incidence of asbestos-related lung diseases is expected to continue to rise. Although much attention is devoted to malignant diseases induced by asbestos, benign asbestos pleural diseases (pleural plaques, benign asbestos-related pleural effusion, diffuse pleural thickening, and rounded atelectasis) are common in clinical practice and often produce diagnostic difficulties. The authors describe the clinical features of benign asbestos-related pleural disease, before focusing on recent advances in radiology and on controversies surrounding the pathogenesis of asbestos-induced pleural injury. Advances in computed tomography have assisted the understanding and diagnosis of these diseases, and increasing evidence suggests radiologic appearances on computed tomography can predict impairment in pulmonary function tests. The pathogenesis of asbestos-induced pleural diseases has also been subject to extensive investigation. Asbestos fibers can provoke pleural inflammation from direct toxicity to mesothelial cells. Inhaled asbestos fibers can also elicit pleural injury indirectly via the release of growth factors and inflammatory cytokines from within the lung. Although progress has been made in the understanding of the mechanisms of asbestos pleural injury, many important questions remain unanswered. The role of genetic factors and possible environmental cofactors (eg, simian virus 40) in the pathogenesis of benign asbestos pleural diseases requires further research.
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Affiliation(s)
- Stephen J Chapman
- Osler Chest Unit, Churchill Hospital, Oxford, UK, and Department of Medicine, University of Western Australia, Perth, Australia
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Chibante AMS, Ferreira TT, Miranda S. [Pleural thickening and tuberculous effusion: searching for predictive data]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2003; 9:9-18. [PMID: 12958664 DOI: 10.1016/s0873-2159(15)30661-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Tuberculosis is a very common disease usualy related to bad social-economic conditions and sometimes with associated pleural effusion. Pleural sequelae are referred by some authors as a consequence that may interfere with lung function provoking respiratory failure in some critical situations. Some experts try to find clinical and biochemical parameters in order to detect possibilities that could predict future pleural thickening and necessity of closer vigilance to avoid lung function disability. This study is based on the post-treatment roentgenological pleural findings and their correlation with the initial pleural fluid biochemical data, the volume of the effusions and time of patients complains.
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Roach HD, Davies GJ, Attanoos R, Crane M, Adams H, Phillips S. Asbestos: when the dust settles an imaging review of asbestos-related disease. Radiographics 2002; 22 Spec No:S167-84. [PMID: 12376609 DOI: 10.1148/radiographics.22.suppl_1.g02oc10s167] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Asbestos-related neoplastic and nonneoplastic diseases of the lungs and pleura range from pleural effusion and pleural plaques to lung cancer and malignant mesothelioma. Pleural effusions are typically hemorrhagic exudates of mixed cellularity but do not typically contain asbestos bodies. The classic distribution of pleural plaques seen on chest radiographs is the posterolateral chest wall between the seventh and tenth ribs, lateral chest wall between the sixth and ninth ribs, the dome of the diaphragm, and the mediastinal pleura. Computed tomographic (CT) findings support this distribution but also show anterior and paravertebral plaques not well shown at chest radiography. Imaging features of diffuse pleural thickening include a continuous sheet, often involving the costophrenic angles and apices, that rarely calcifies. The typical CT features of round atelectasis are of a round or oval mass that abuts the pleura, a "comet tail" of bronchovascular structures going into the mass, and thickening of the adjacent pleura. Features of asbestosis on chest radiographs include ground-glass opacification, small nodular opacities, "shaggy" cardiac silhouette, and ill-defined diaphragmatic contours. CT, however, is more sensitive in their detection. Chest radiography in patients with malignant mesothelioma may show an effusion, pleural thickening, and as the tumor progresses, a more lobulated outline. CT can help identify the disease in its early stages. Asbestos-related cancers can occur anywhere in the lungs. Recognition of the clinical, radiologic, and pathologic features of these diseases will be important for some years to come.
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Affiliation(s)
- Huw D Roach
- Department of Radiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
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