Learning Radiology xray montage

Asbestos-Related Pleural Disease


General Considerations

  • Salts of salicic acid
  • 90% of asbestos in the USA is white asbestos (chrysotile) occurs in automotive workers, shipfitters, construction workers
  • Asbestos particles invoke a hemorrhagic response in the lung
  • Fibers are then coated with a ferritin-like material resulting in ferruginous bodies
  • Produces its damage in respiratory bronchioles and alveoli
  • Affects lower lobes first
  • The presence of pulmonary parenchymal changes differentiates asbestosis from asbestos-related pleural disease

Imaging Findings

  • Opacities are small and irregularly shaped
  • Cardiac silhouette may become shaggy
  • All patients with asbestos-related pleural disease have, by definition, some pleural involvement
  • Pleural involvement without parenchymal disease is common
  • Pleural plaque
    • Parietal pleural plaques in the mid lung are the most common asbestos-related disorder and are usually bilateral
    • They occur most often in the 6th-9th interspaces usually sparing the apices and lung bases and involve the parietal pleura
  • Diffuse pleural thickening
    • Less common than pleural plaques
    • Diffuse pleural thickening involves diaphragmatic pleura, blunting of costophrenic sulci and lateral pleural thickening
  • Pleural calcification
    • Pleural calcification occurs in about 50% with asbestos-related disease, especially along the diaphragmatic pleura
    • Calcified pleural plaques seen en face have a characteristic rolled edge along their margins, denser than in the central portion of the plaque
    • The appearance of the entire plaque has been likened to a holly leaf
    • Later manifestation of pleural disease, calcification may occur in plaque or diffuse pleural thickening (less often)
  • Pleural effusion
    • Effusion alone may occur early in the disease (first 20 years) in about 3% of cases
    • Exudative, occasionally bloody, one-sided or bilateral
  • In contrast to silicosis, hilar lymph nodes are rarely affected

Associations with lung cancer and mesothelioma

  • Estimated to occur in 20-25% of those heavily exposed to asbestos
  • Asbestos-related lung cancer is usually either squamous cell or adenocarcinoma
  • Bronchogenic carcinoma is almost always associated with cigarette smoking
  • Increases risk of bronchogenic carcinoma up to 100x over that in non-smoking, non-asbestos exposed population
  • Mesotheliomas are not related to cigarette smoking
  • Mesotheliomas most often due to crocidolite particles


Asbestos-Related Pleural Disease

Asbestos-Related Pleural Disease. There are innumerable pleural plaques, seen mostly en face. They have a typical appearance called a "rolled-edge" (red arrows. They have been likened to the appearance of a "holly leaf." There is also plaque-like, pleural calcification present (yellow arrows).

Asbestos-Related Pleural Disease

Asbestos-Related Pleural Disease. Again, there are innumerable pleural plaques, seen both en face (white arrows) and in profile (black arrows).