48 y/o with dyspnea

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Doctor's Information

Name : Shahram
Family : Kahkoueei
Affiliation :Radiology deparment,masih hospital,SBMU
Academic Degree : Assistant Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Elham Dehgham

Case Section

Chest Imaging

Patient's Information

Gender : Male
Age : 48

Clinical Summary

48 y/o man with dyspnea

Imaging Findings

There are some calcified and non calcified pleural plaques associated with right sided plural thickening , bilateral pleural effiution and adjacent round atelectasis .

Differential Diagnosis

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Final Diagnosis

Asbestosis related lung and plural disease

Discussion (Related Text)

Asbestosis typically occurs 10 - 15 years following the commencement of exposure to asbestos and is dose related .Clinical presentation is insidious and non-specific with shortness of breath prompting imaging. Alternatively, the presence of asbestosis may become evident when a patient presents with other asbestos related diseases.Asbestosis is histologically very similar to usual interstitial pneumonia (UIP) with the addition of asbestos bodies . iThere are no pathognomonic radiological features specific for asbestosis.Plain films may show may irregular opacities with a fine reticular pattern. Additional evidence of asbestos exposure such as calcified or non-calcified pleural plaques may be evident. Appearances of asbestosis vary with the duration and severity of the condition. Early manifestations are largely confined to the peripheral region of the lower zones and are subtle. They include: centrilobular dot-like opacities : peribronchiolar fibrosis intralobular linear opacities : reticulation sub pleural lines (often curvilinear) These changes may be similar in appearance to dependent atelectasis, especially when located posteriorly, and thus supine and prone scans are recommended . As the fibrosis progresses, a number of more definite findings are seen, which continue to be particularly subpleural and lower lung zone in distribution. They include: parenchymal bands traction bronchiectasis honeycomb fibrosis Pleural effusions and pleural plaques are common manifestations of asbestos related disease, however hilar and mediastinal lymphadenopathy is usually absent. A careful search for malignancy both of the lung (bronchogenic carcinoma) and pleura (mesothelioma) should be undertaken especially in nodal enlargement is seen.

References

1. Chong S, Lee KS, Chung MJ et-al. Pneumoconiosis: comparison of imaging and pathologic findings. Radiographics. 26 (1): 59-77. doi:10.1148/rg.261055070 - Pubmed citation 2. Roach HD, Davies GJ, Attanoos R et-al. Asbestos: when the dust settles an imaging review of asbestos-related disease. Radiographics. 2002;22 Spec No : S167-84. Radiographics (link) - Pubmed citation 3. Naidich DP, Srichai MB, Krinsky GA. Computed tomography and magnetic resonance of the thorax. Lippincott Williams & Wilkins. (2007) ISBN:0781757657. Read it at Google Books - Find it at Amazon 4. Akira M, Yamamoto S, Inoue Y et-al. High-resolution CT of asbestosis and idiopathic pulmonary fibrosis. AJR Am J Roentgenol. 2003;181 (1): 163-9. AJR Am J Roentgenol (full text) - Pubmed citation 5. Kilburn KH, Warshaw RH. Severity of pulmonary asbestosis as classified by International Labour Organisation profusion of irregular opacities in 8749 asbestos-exposed American workers. Those who never smoked compared with those who ever smoked. Arch. Intern. Med. 1992;152 (2): 325-7. Arch. Intern. Med. (link) - Pubmed citation