8th Baltic Congress of Radiology

Thoracic Radiology

oral abstract

Asbestos refers to a group of six silicate minerals. For resistance to fire, heat and electricity it was widely used in 19th and 20th century for insulation. Asbestos is very cancerogenic and can cause pleural mesothelioma, lung cancer and some other forms of neoplasms. In addition to this it can cause another debilitating fibrotic lung disease - asbestosis. Benign pleural thickening, pleural plaques and pleural effusion are benign diseases caused by asbestos. Even though asbestos is banned in Europe, Australia, part of South America, China and some other countries, asbestos related diseases are still widely spread word-wide due to long latency period (15-60 years). The aim of this presentation is to overview different pulmonary and pleural diseases related to asbestos exposure and present their radiological manifestations.

Non-systemic review of asbestos related diseases was performed.

Benign pleural effusion is the earliest presentation of asbestos related disease and has to be differentiated from other causes of hydrothorax. Pleural thickening can occur when the effusion resolves. Diffuse pleural thickening usually does not calcify and surrounds whole lung including apices and costophrenic angles. Pleural plaques are the most common manifestation and evidence of asbestos exposure. Pleural plaques can be both calcified and non calcified. If plaque is located in visceral pleura, fibrotic bands arising from the plaque can develop. Pleural plaques or pleural thickening can cause developement of round atelectasis. Ion the CT scan round atelectasis appears as enhancing pulmonary mass with comet tail sign and is broadly connected to pleura. CT findings might be non-conclusive and other tests, including PET-CT, MR and biopsy might be needed. Asbestosis is a fibrotic lung disease. In plain films fibrotic changes, “shaggy” heart and blunted costophrenic angles are seen. Most common CT findings are fibrotic bands, sub-pleural lines, traction bronchiectasis and honeycombing. Asbestosis is more prominent in lower zones, but can involve middle lobe or lingula and even extend to the upper lobes in advanced disease. Pleural mesothelioma manifests as smooth or nodular pleural thickening, that can extend to pleural fissures, an is usually related with loculated pleural effusion. In case of widespread thickening hemithorax becomes contracted. Mesothelioma can directly invade surounding structures like chest wall, pericardium, diaphragm and other surrounding structures. Primary pulmonary malignancy manifest in its usuall manner.

Asbestos can cause wide variety of diseases including asbestosis and malignant tumours. Knowledge of natural history of diseases and imaging findings are important for timely diagnosis.

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