Benign asbestos pleural effusion

Abstract

Unatoč sve češćoj pojavi slučajeva pleuralne i plućne azbestoze malen je do danas objavljen broj slučajeva benignog azbestnog pleuralnog izljeva. Razlog tome je prije svega općenito malo poznati kauzalni odnos između ekspozicije azbestu i pleuralnog izljeva pa tako može i etiologija ponekog »banalnog« slučaja izljeva ostati nerazjašnjena naročito kada nema drugih znakova pleuropulmonalne azbestoze. S druge strane, zbog oskudice simptoma kod malih izljeva ta manifestacija azbestoze se vrlo lako može previdjeti. Međutim, smatra se da je benigni pleuralni izljev, za razliku od malignog, jedan od najranijih kliničkih učinaka azbestoze koji se pojavljuje 10 ili manje godina nakon početka kontinuirane pa čak i intermitentne ekspozicije a zato i u mlađoj dobi. Od pet prikazanih bolesnika s benignim pleuralnim izljevom dva su bila mlađa od 35 godina, dva su bila u 41. godini a samo jedan u 48. godini. Svi su bili brodogradilišni radnici, i to tri brodostolari, jedan termoizolater a jedan varilac. Intersticijalna parenhimna fibroza razvila se kod četvorice: kod jednog je nađena istodobno s izljevom, kod trojice naknadno (3, 10 i 16 godina kasnije) a kod jednog se nije pojavila uopće u 5 godina kontrolnog promatranja. Koliko su autori mogli provjeriti ovo je prvo kazuističko proučavanje benignog azbestnog pleuralnog izljeva u Jugoslaviji.Despite an ever-increasing incidence of pleural and pulmonary asbestosis the number of cases of benign asbestos pleural effusion reported to date has been small. This is due primarily to the fact that the causal relationship between asbestos exposure and pleural effusion has not been widely recognized and thus the aetiology of a few cases of »banal« effusion may remain obscure, particularly when other signs of pleuro-pulmonary asbestosis are lacking. On the other hand, due to the sparsity of symptoms in small effusions this manifestation of asbestosis may be very easily overlooked. However, a benign pleural effusion, contrary to a malignant one, is considered to be one of the earliest clinical effects of asbestosis appearing 10 years or less after the beginning of continuous or even intermittent exposure, and in younger age groups. Out of five patients with benign asbestos effusion reported here, two were less than 35 years of age, two were 40 years and only one was 48. They were all dockyard workers: three of them were ship-fitters, one an insulator and one a welder. Interstitial parenchymal fibrosis developed in four of them: in one it was found simultaneously, in three it followed later (3, 10 and 16 years later), and in one it did not appear during the follow-up period (5 years) at all. As far as the authors have been able to ascertain, this is the first case study of benign asbestos pleural effusion in Yugoslavia