Review Question - QID 100824

The patient history given is constant with asbestos exposure with past work in shipyards, presenting with fibrocalcific parietal pleural plaques on the diaphragm.

Asbestosis can result in several different pathological lesions. In early stages it can cause benign fibrocalcific parietal pleural plaques, predominantly of the posterio-lateral mid lung and diaphragm. It is common to discover these lesions in asymptomatic patients during routine chest x-rays. Later, it can result in fibrotic lung disease, mesothelioma or other lung malignancies.

Baker et al. examine many of the screening methods used for forms of pulmonary lung diseases as a result of occupational exposure. Most importantly, they describe three main mechanisms to reduce asbestos-related morbidity and mortality: (1) preventing exposures in the workplace, (2) pre-market toxicity testing of new chemicals and technologies, and (3) astute clinical diagnosis.

Matsuzaki et al. report the cellular interaction with asbestos by studying peripheral blood samples derived from patients with pleural plaque and mesothelioma that have been exposed to asbestos. According to their work, immunocompetent cells are altered by chronic and recurrent encounters with asbestos fibers, which leads to decreased tumor immunity.

Illustration A displays a post-mortum example of calcified diaphragmatic plaques as a result of asbestos exposure. Illustration B depicts an overview of the effects of asbestos on the lungs over time. Illustration C is a chest xray showing a left lower fibrocalcific plaque consistant with mesothelioma.

Incorrect Answers:
Answer 1: This presentation is typical of sarcoidosis
Answer 3: This presentation is typical of emphysema.
Answer 4: This presentation is typical of latent tuberculosis.
Answer 5: Asbestosis would present with classic radiographic findings described in the answer.