Asbestos-Related Lung Disease: A Pictorial Review

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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.

Introduction

Asbestos is a generic term for fibrous silicate minerals that are heat resistant. The material was commonly used in manufacturing, mining, and construction during the industrial era. Overall, approximately 2-6 million people have been exposed in the United States. The 9/11 Twin Tower attack and Hurricane Katrina are recent events that have critically exposed many people to asbestos. There are 2 morphologic types of silicates: amphibole and serpentine fibers. The amphiboles are straight, rigid, needlelike fibers. The major types of amphiboles are crocidolite (blue asbestos), amosite (brown asbestos), tremolite, and anthophyllite (the rarest). Altogether, these account for only 10% of the asbestos in use. Serpentine accounts for the other 90%. Chrysotile (white asbestos), the only serpentine of commercial importance commonly used today, has curly, pliable fibers that readily decompose into finer particles.1 There are 2 major sources of exposure to asbestos dust: (a) the primary occupations of asbestos mining and processing and (b) secondary occupations such as insulation manufacturing, textile manufacturing, construction, shipbuilding, and the manufacture and repair of gaskets and brake linings.2

Section snippets

Pleural Effusions

Pleural effusions are the earliest and most common abnormality seen with asbestos exposure; they are usually seen within the first 10-20 years. They may occur even after minimal exposure to asbestos.3 Effusions are of mixed cellularity and do not contain asbestos fibers. They tend to be exudative and often hemorrhagic and can have an increased eosinophil count.3 Although the effusions are usually small, they can recur or occur bilaterally. Effusions typically must be large to cause symptoms;

Rounded Atelectasis

Rounded atelectasis, also called “folded lung,” “Blesovsky syndrome,” “atelectatic pseudotumor,” and “pulmonary pseudotumor,” refers to peripheral atelectatic lung adjacent to an area of pleural thickening with characteristic drawing in of the bronchi and vessels into the atelectatic lung.13, 14, 15 It is strongly associated with asbestos exposure. However, any entity that leads to the formation of organized pleural exudate, such as tuberculosis, histoplasmosis, Dressler syndrome following

Malignant Mesothelioma

Malignant mesothelioma is known to be highly associated with asbestos exposure and occurs primarily in the pleura and the peritoneum, but it can also arise in the pericardium, tunica vaginalis testis, larynx, and kidney. Asbestos exposure has also been suggested as a contributor to nodular pulmonary amyloidosis.4

Epidemiology

Malignant pleural mesothelioma (MPM) is the most common primary neoplasm of the pleura32, 33 but still a rare tumor. Pleural mesothelioma is strongly associated with asbestos—only 20%

Conclusion

Asbestos-related lung disease is a condition that has affected many patients and will affect many more in the years to come. Exposure to asbestos causes multiple effects on the lung parenchyma and pleura. Radiologists have an integral role in the diagnosis and management of these patients. Recognizing the imaging appearance of the pleural disease, lung parenchymal disease, and neoplastic disease caused by asbestos exposure is crucial to getting these patients the proper treatment.

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