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Understanding Asbestosis: Radiographic Findings and Differential Diagnosis

Learn about the radiographic features of asbestosis, including pleural effusion, plaque formation, pulmonary fibrosis, and more. Discover the association between asbestosis and malignancies like mesothelioma and bronchial carcinoma. Explore differential diagnoses and key findings in imaging.

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Understanding Asbestosis: Radiographic Findings and Differential Diagnosis

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  1. ASPESTOSIS Radiographic findings Ritchie O. Rosso Jr. Smd ‘05

  2. Clinic History • 88 year old male, presenting for pre-op CXR for anticipated unilateral hip replacement by Ortho • No current pulmonary symptoms other than mild SOB on exertion • History of CAD (3 vessel CABG in 2001) • 40 pack-year smoking history; quit “quite a few years ago.” Worked on factory line for Dupont x 40 years.

  3. Hopital course • Pt. did well through surgery, but developed moderate CP with small troponin leak and was transferred to Cardiology service. Stress test done revealed “low risk,” and pt. subsequently discharged on 7/9/04 with long list home meds (including many pulmonary meds + O2) • Had previous admission 5/01 for SOB and accumulation pulmonary fluid, after which he underwent CABG

  4. Radiographic features of Aspestosis • Benign pleural effusion (usually w/in 10 yrs. of exposure) • Pleural plaque formation +/- calcification • Pleural thickening • Rounded atelectasis • Pulmonary fibrosis (usually >20 yrs. after exposure) • Malignant mesothelioma • Bronchial carcinoma

  5. Findings/diff diagnosis • Nodular shadows associated with short line shadows are seen in fibrosing alveolitis whatever the cause (especially pneumoconioses such as coal workers’ lungs, tin handlers, aspestosis) • Allergic alveolitis • Late stage xanthomatous lesions (Histiocytosis X)

  6. Aspestosis • Amphibole fibers (straight fibers) more carcinogenic than chrysotile (curved fibers) • Smokers with aspestos exposure 60-70 times more likely than nonsmokers to develop bronchogenic carcinoma

  7. References/ACR code • Radiology Recall. Spencer B. Gay, Richard J. Woodcock. 2000. pp. 112 • Diagnosis of Diseases of the Chest. Fraser, Pare, genereux. 1989. pp.1333-1335. • ACR 66.77

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