Asbestos pleurisy is the occurrence of small benign (Görlitz 2010) pleural effusions after exposure to asbestos (Herold 2022). It usually occurs unilaterally in the early stage, later also bilaterally (Hien 2012).
Asbestos pleuritisJ92.0
DefinitionThis section has been translated automatically.
Occurrence/EpidemiologyThis section has been translated automatically.
Asbestos pleurisy is the most common pleuro-pulmonary complication following exposure to asbestos (Herold 2022). It occurs in about 20% of those exposed (Hien 2012).
EtiopathogenesisThis section has been translated automatically.
Caused by exposure to asbestos (Herold 2022).
PathophysiologyThis section has been translated automatically.
After inhalation of dusts containing asbestos fibers, they are deposited in the pleural area and trigger an inflammatory mesothelial reaction (Kroegel 2013).
ManifestationThis section has been translated automatically.
Asbestos pleurisy manifests in the first 20 years after exposure (Herold 2022).
LocalizationThis section has been translated automatically.
Initially, it usually occurs unilaterally, but can be detectable bilaterally as the disease progresses (Hien 2012).
Clinical featuresThis section has been translated automatically.
Recurrent small pleural effusions are found, often without further symptoms (Herold 2022).
However, there may also be:
- fever
- Feeling of illness (Hien 2012)
DiagnosticsThis section has been translated automatically.
Diagnosis is made by cytologic and biochemical examination of pleural effusions and pleural biopsies, respectively (Kishimoto 2014).
ImagingThis section has been translated automatically.
Chest X-ray
The diagnosis of asbestos pleurisy is usually made radiologically (Kraus 2020).
Sonography
Sonographic evidence of unilateral or bilateral effusions can be obtained.
LaboratoryThis section has been translated automatically.
- BSG increase (Hien 2012)
HistologyThis section has been translated automatically.
In the majority of cases, the exudate is serous or bloody (Kasper 2015) and tinged with granulocytes (or bloody) (Hien 2012).
It may be present and complicate differentiation from mesothelioma:
- clustered mitoses
- Irritant forms
- cell atypia
- proliferating mesothelial cells in connective tissue
- Eosinophilia (more indicative of asbestos pleurisy).
(Hien 2012)
Electron microscopically, asbestos fibers may be detectable. Only rarely are asbestos bodies found by light microscopy (Hien 2012).
Differential diagnosisThis section has been translated automatically.
Differentiation from mesothelioma is often difficult (Hien 2012). Mesothelioma can only be excluded after 3 years of follow-up (Konietzko 2006).
- Tuberculosis
- Infections with pleural involvement
- Tumor disease (Kraus 2020)
Complication(s)This section has been translated automatically.
- Fibrosis
It is not uncommon for asbestos pleurisy to cause pleural fibrosis (Hien 2012).
- Verschwartung
After spontaneous regression, asbestos pleuritis leaves a Verschwartung of the diaphragm-rib angle (Hien 2012). Typical is the Verschwartung of the pleura in the sense of a Hyalinosis complicata (Raithel 1996).
- Round atelectasis
These are usually symmetrical and are found predominantly in the dorsobasal lower lobes after asbestos pleuritis. They are typical of benign asbestos injury but are not specific (Kraus 2020).
If pericarditis is also present, there is a risk of pericardial ta
TherapyThis section has been translated automatically.
Since the disease usually heals spontaneously within 6 months, no therapy is required in most cases (Kroegel 2013).
Internal therapyThis section has been translated automatically.
Medications that can be used for symptomatic treatment include anti-inflammatories such as diclofenac (Hien 2012)
Operative therapieThis section has been translated automatically.
In persistent effusions, pleurodesis may be required (Hien 2012).
Progression/forecastThis section has been translated automatically.
The effusion may regress spontaneously or slowly (Kasper 2015). It is not uncommon for progression to be followed by severe defect healing with diffuse pleural fibrosis and severe restriction, sometimes even respiratory insufficiency (Konietzko 2006).
LiteratureThis section has been translated automatically.
- Görlitz S (2010) Asbestos-related benign pleural and pulmonary diseases. The pulmonologist (7) 7 - 18.
- Herold G et al (2022) Internal medicine. Herold Publishers 399
- Hien P (2012) Asbestos-related diseases. In: Practical pneumology. Springer Verlag Berlin / Heidelberg 263 - 270
- Kasper D L et al (2015) Harrison's Principles of Internal Medicine. Mc Graw Hill Education 1689
- Kishimoto T (2014) Asbestos-related deseases. Nihon Rinsho 72 (2) 300 - 305.
- Konietzko N et al (2006) Curriculum Pneumologicum 2005 part 2. pneumology 60 (2) 119 - 129.
- Kraus T et al (2020) Diagnosis and assessment of asbestos-related occupational diseases. Interdisciplinary S2k guideline of the German Society of Pneumology and Respiratory Medicine and the German Society of Occupational and Environmental Medicine.
- Kroegel C et al. (2013) Clinical pneumology: the reference work for clinic and practice. Thieme Verlag chapter 9.12
- Raithel J et al. (1996) Asbestos-related occupational diseases: current occupational medical and clinical diagnostic aspects.Dtsch Arztebl 93 (11) A - 685 / B 592 / C 541.