Asbestos-related Pleuropulmonary Diseases: Pictorial Essay [alterações Pleurais E Parenquimatosas Relacionadas Com A Exposição Ao Asbesto: Ensaio Pictórico]

Pleural and pulmonary asbestos-related diseases range from benign conditions, like pleural effusion and pleural plaques, to some neoplasias, such as lung cancer and malignant mesothelioma. Pleural effusion is the earliest finding after asbestos exposure, but the imaging findings are not specific. Diffuse pleural thickening involves the visceral pleura and pleural plaques are considered to be hallmarks of exposure. Asbestosis is the pulmonary fibrosis due to asbestos. Rounded atelectasis is a peripheral lung collapse in these individuals, generally related to pleural disease. Some neoplasias, like lung carcinoma and pleural mesothelioma, are more prevalent in asbestos-exposed subjects. The aim of this essay is to illustrate the main imaging findings of asbestos-related diseases.115477485Aberle, D.R., Balmes, J.R., Computed tomography of asbestos-related pulmonary parenchymal and pleural diseases (1991) Clin. Chest Med., 12 (1), pp. 115-131Webb, W.R., Müller, N.L., Naidich, D.P., Asbestosis and asbestos-related disease (2001) High-resolution CT of the Lung, pp. 236-257. , 3rd ed. Philadelphia: Lippincott Williams & WilkinsKim, K.I., Kim, C.W., Lee, M.K., Lee, K.S., Park, C.K., Choi, S.J., Imaging of occupational lung disease (2001) Radiographics, 21 (6), pp. 1371-1391Staples, C.A., Computed tomography in the evaluation of benign asbestos-related disorders (1992) Radiol. Clin. North Am., 30 (6), pp. 1191-1207Epler, G.R., McLoud, T.C., Gaensler, E.A., Prevalence and incidence of benign asbestos pleural effusion in a working population (1982) JAMA, 247 (5), pp. 617-622Hillerdal, G., Ozesmi, M., Benign asbestos pleural effusion: 73 exudates in 60 patients (1987) Eur. J. Respir. Dis., 71 (2), pp. 113-121Wernecke, K., Ultrasound study of the pleura (2000) Eur. Radiol., 10 (10), pp. 1515-1523Gevenois, P.A., Trogrlic, S., Imaging of the pleura (1997) Rev. Prat., 47 (12), pp. 1304-1307Solomon, A., Radiological features of asbestos-related visceral pleural changes (1991) Am. J. Ind. Med., 19 (3), pp. 339-355Lynch, D.A., Gamsu, G., Aberle, D.R., Conventional and high resolution computed tomography in the diagnosis of asbestos-related diseases (1989) Radiographics, 9 (3), pp. 523-551Jones, R.N., Pleural plaques: Diagnostic problems and significance (1997) Indoor Built. Environ., 6, pp. 106-113Hillerdal, G., Nonmalignant pleural disease related to asbestos exposure (1985) Clin. Chest Med., 6 (1), pp. 141-152Christen, B., Wegmann, W., Vogt, P., Clinical pathology and histology of pleural plaques (1997) Indoor Built Environ., 6, pp. 79-85Peacock, C., Copley, S.J., Hansell, D.M., Asbestos-related benign pleural disease (2000) Clin. Radiol., 55 (6), pp. 422-432Roach, H.D., Davies, G.J., Attanoos, R., Crane, M., Adams, H., Phillips, S., Asbestos: When the dust settles an imaging review of asbestos-related disease (2002) Radiographics, 22, pp. S167-S184. , Spec NoBecklake, M.R., Asbestos-related diseases of the lung and other organs: Their epidemiology and implications for clinical practice (1976) Am. Rev. Respir. Dis., 114 (1), pp. 187-227Gamsu, G., Salmon, C.J., Warnock, M.L., Blanc, P.D., CT quantification of interstitial fibrosis in patients with asbestosis: A comparison of two methods (1995) AJR Am. J. Roentgenol., 164 (1), pp. 63-68McLoud, T.C., Conventional radiography in the diagnosis of asbestos-related disease (1992) Radiol. Clin. North Am., 30 (6), pp. 1177-1189Aberle, D.R., Gamsu, G., Ray, C.S., Feuerstein, I.M., Asbestos-related pleural and parenchymal fibrosis: Detection with high-resolution CT (1988) Radiology, 166 (3), pp. 729-734Friedman, A.C., Fiel, S.B., Fisher, M.S., Radecki, P.D., Lev-Toaff, A.S., Caroline, D.F., Asbestos-related pleural disease and asbestosis: A comparison of CT and chest radiography (1988) AJR Am. J. Roentgenol., 150 (2), pp. 269-275Hillerdal, G., Rounded atelectasis. Clinical experience with 74 patients (1989) Chest, 95 (4), pp. 836-841McHugh, K., Blaquiere, R.M., CT features of rounded atelectasis (1989) AJR Am. J. Roentgenol., 153 (2), pp. 257-260Hillerdal, G., The pathogenesis of pleural plaques and pulmonary asbestosis: Possibilities and impossibilities (1980) Eur. J. Respir. Dis., 61 (3), pp. 129-138Bégin, R., Samet, J.M., Shaikh, R.A., Asbestos (1996) Occupational and Environmental Respiratory Disease, pp. 293-321. , Saint Louis: Mosby-Year BookAkira, M., Yokoyama, K., Yamamoto, S., Higashihara, T., Morinaga, K., Kita, N., Early asbestosis: Evaluation with high-resolution CT (1991) Radiology, 178 (2), pp. 409-416Medical Section of the American Lung Association: The diagnosis of non-malignant diseases related to asbestos (1986) Am. Rev. Respir. Dis., 134 (2), pp. 363-368. , American Thoracic SocietyAkira, M., Yamamoto, S., Inoue, Y., Sakatani, M., High-resolution CT of asbestosis and idiopathic pulmonary fibrosis (2003) AJR Am. J. Roentgenol., 181 (1), pp. 163-169Lemen, R.A., Dement, J.M., Wagoner, J.K., Epidemiology of asbestos-related diseases (1980) Environ. Health Perspect., 34, pp. 1-11Garg, K., Lynch, D.A., Imaging of thoracic occupational and environmental malignancies (2002) J. Thorac. Imaging, 17 (3), pp. 198-210Adams, V.I., Unni, K.K., Muhm, J.R., Jett, J.R., Ilstrup, D.M., Bernatz, P.E., Diffuse malignant mesothelioma of pleura. Diagnosis and survival in 92 cases (1986) Cancer, 58 (7), pp. 1540-1551Gottschall, E.B., Occupational and environmental thoracic malignancies (2002) J. Thorac. Imaging, 17 (3), pp. 189-197Muller, N.L., Imaging of the pleura (1993) Radiology, 186 (2), pp. 297-309Nishimura, S.L., Broaddus, V.C., Asbestos-induced pleural disease (1998) Clin. Chest Med., 19 (2), pp. 311-329McLoud, T.C., CT and MR in pleural disease (1998) Clin. Chest Med., 19 (2), pp. 261-276Marom, E.M., Erasmus, J.J., Pass, H.I., Patz Jr., E.F., The role of imaging in malignant pleural mesothelioma (2002) Semin. Oncol., 29 (1), pp. 26-35Heelan, R.T., Rusch, V.W., Begg, C.B., Panicek, D.M., Caravelli, J.F., Eisen, C., Staging of malignant pleural mesothelioma: Comparison of CT and MR imaging (1999) AJR Am. J. Roentgenol., 172 (4), pp. 1039-1047Benard, F., Sterman, D., Smith, R.J., Kaiser, L.R., Albelda, S.M., Alavi, A., Prognostic value of FDG PET imaging in malignant pleural mesothelioma (1999) J. Nucl. Med., 40 (8), pp. 1241-1245Zubeldia, J., Abou-Zied, M., Nabi, H., Evaluation of Patients with Known Mesothelioma with 18F-Fluorodeoxyglucose and PET. Comparison with Computed Tomography (2000) Clin. Positron Imaging, 3 (4), p. 16

Placas pleurais relacionadas com o asbesto: Revisão da literatura

Resumo: As placas pleurais (PP) são espessamentos focais da pleura, consideradas marcadores de exposição ao asbesto. Geralmente encontradas na ausência de alterações pulmonares, podem envolver a pleura parietal, diafragmática e, menos comummente, mediastinal. Embora a radiografia simples de tórax seja o método mais comummente utilizado no diagnóstico das PP, a tomografia computadorizada é o exame de imagem com maiores sensibilidade e especificidade, especialmente quando empregada a técnica de alta resolução. As PP geralmente não causam sintomas, mas ainda existem controvérsias quanto à relação entre as mesmas e índices de exposição ao asbesto, alterações funcionais pulmonares e risco de desenvolvimento de neoplasias.Rev Port Pneumol 2005; XI (5): 487-497 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.Rev Port Pneumol 2005; XI (5): 487-497 Unitermos: Asbesto, pleura, anormalidades, tomografia computadorizada por raios-X, pneumo-conioses, doenças ocupacionais, Key-words: Asbestos, pleura, abnormalities, HRCT, pneumoconioses, occupational disease

Alterações pleurais e parenquimatosas relacionadas com a exposição ao asbesto: Ensaio pictórico

Resumo: As alterações pleurais e pulmonares decorrentes da exposição ao asbesto podem ser benignas, como o derrame e as placas pleurais, ou malignas, como o carcinoma de pulmão e o mesotelioma pleural. O derrame pleural é a manifestação mais comum nos primeiros anos após a exposição e os aspectos de imagem são incaracterísticos. O espessamento pleural difuso compromete a pleura visceral, não sendo específico da exposição ao asbesto. As placas pleurais, espessamentos focais da pleura, são consideradas marcadores de exposição. A asbestose corresponde à fibrose do parênquima pulmonar pelo asbesto, predominando nos lobos inferiores, e a atelectasia redonda a um colapso pulmonar periférico, geralmente associado a alterações pleurais. O carcinoma pulmonar e o mesotelioma pleural são mais prevalentes em indivíduos expostos. O objectivo deste estudo é ilustrar as principais alterações de imagem das alterações relacionadas com o asbesto.Rev Port Pneumol 2005; XI (5): 477-485 Abstract: Pleural and pulmonary asbestos-related diseases range from benign conditions, like pleural effusion and pleural plaques, to some neoplasias, such as lung cancer and malignant mesothelioma. Pleural effusion is the earliest finding after asbestos exposure, but the imaging findings are not specific. Diffuse pleural thickening involves the visceral pleura and pleural plaques are considered to be hallmarks of exposure. Asbestosis is the pulmonary fibrosis due to asbestos. Rounded atelectasis is a peripheral lung collapse in these individuals, generally related to pleural disease. Some neoplasias, like lung carcinoma and pleural mesothelioma, are more prevalent in asbestos-exposed subjects. The aim of this essay is to illustrate the main imaging findings of asbestos-related diseases.Rev Port Pneumol 2005; XI (5): 477-485 Palavras-chave: Asbesto, pneumoconioses, doenças ocupacionais, Key-words: Asbestos, pneumoconioses, occupational disease

Asbestos-related Pleural Plaques: A Literature Review [placas Pleurais Relacionadas Com O Asbesto: Revisão Da Literatura]

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.115487497Bégin, R., Asbestos-related lung diseases (1998) Occupational Lung Disease, pp. 219-238. , London: Chapman & HallBégin, R., Samet, J.M., Shaikh, R.A., Asbestos (1996) Occupational and Environmental Respiratory Disease, pp. 293-321. , Saint Louis: Mosby-Year BookKim, K.I., Kim, C.W., Lee, M.K., Lee, K.S., Park, C.K., Choi, S.J., Imaging of occupational lung disease (2001) Radiographics, 21 (6), pp. 1371-1391Jones, R.N., Pleural plaques: Diagnostic problems and significance (1997) Indoor. Built. Environ., 6, pp. 106-113Becklake, M.R., Asbestos-related diseases of the lung and other organs: Their epidemiology and implications for clinical practice (1976) Am. Rev. Respir. 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Radiol., 55 (6), pp. 422-432Hillerdal, G., Pleural plaques: Incidence and epidemiology, exposed workers and the general population (1997) Indoor. Built. Environ., 6, pp. 86-95Van Cleemput, J., De Raeve, H., Verschakelen, J.A., Rombouts, J., Lacquet, L.M., Nemery, B., Surface of localized pleural plaques quantitated by computed tomography scanning: No relation with cumulative asbestos exposure and no effect on lung function (2001) Am. J. Respir. Crit. Care Med., 163 (3 PART 1), pp. 705-710Jones, R.N., McLoud, T., Rockoff, S.D., The radiographic pleural abnormalities in asbestos exposure: Relationship to physiologic abnormalities (1988) J. Thorac. Imaging, 3 (4), pp. 57-66Delclos, G.L., Wilson, R.K., Bradley, B.L., Influence of smoking on radiographic profusion and pleural changes in asbestos-exposed subjects (1990) J. Occup. Med., 32 (7), pp. 577-581Jones, R.N., Diem, J.E., Hughes, J.M., Hammad, Y.Y., Glindmeyer, H.W., Weill, H., Progression of asbestos effects: A prospective longitudinal study of chest radiographs and lung function (1989) Br. J. Ind. Med., 46 (2), pp. 97-105Organization, I.L., (1980) Guidelines for the Use of the ILO International Classification of Radiographs of Pneumoconioses, , GenevaOrganization, I.L., (2000) Guidelines for the Use of the ILO International Classification of Radiographs of Pneumoconioses, , GenevaWain, S.L., Roggli, V.L., Foster Jr., W.L., Parietal pleural plaques, asbestos bodies, and neoplasia. A clinical, pathologic, and roentgenographic correlation of 25 consecutive cases (1984) Chest, 86 (5), pp. 707-713McLoud, T.C., Conventional radiography in the diagnosis of asbestos-related disease (1992) Radiol. Clin. North Am., 30 (6), pp. 1177-1189Hillerdal, G., Lindgren, A., Pleural plaques: Correlation of autopsy findings to radiographic findings and occupational history (1980) Eur. J. Respir. Dis, 61 (6), pp. 315-319Hillerdal, G., Nonmalignant pleural disease related to asbestos exposure (1985) Clin. Chest Med., 6 (1), pp. 141-152Henry, D.A., International Labor Office Classification System in the age of imaging: Relevant or redundant (2002) J. Thorac. Imaging, 17 (3), pp. 179-188McLoud, T.C., CT and MR in pleural disease (1998) Clin. Chest. Med., 19 (2), pp. 261-276Kreel, L., Computer tomography in the evaluation of pulmonary asbestosis. Preliminary experiences with the EMI general purpose scanner (1976) Acta Radiol. Diagn. (Stockh.), 17 (4), pp. 405-412Al Jarad, N., Poulakis, N., Pearson, M.C., Rubens, M.B., Rudd, R.M., Assessment of asbestos-induced pleural disease by computed tomography - Correlation with chest radiograph and lung function (1991) Respir. 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Pleural Plaques in Asbestos-exposed Workers: Reproducibility of a New High-resolution CT Visual Semiquantitative Measurement Method

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)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.211813Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [96-10415-6