Posts Tagged ‘Thickening’

Pleural Thickening and Profusion Resulting From Asbestos Exposure

Pleural Thickening and Profusion Resulting From Asbestos Exposure

Asbestos exposure is a known cause of cancer.  A plethora of research has been done in the past to establish causation.  One interesting study is called, “Asbestos exposure and asbestos-related pleural and parenchymal disease associations with immune imbalance” by Sprince NL, Oliver LC, McLoud TC, Eisen EA, Christiani DC, Ginns LC – Am Rev Respir Dis. 1991 Apr;143(4 Pt 1):822-8. Medical Services Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, Massachusetts.  Here is an excerpt: “Abstract – The study hypothesis was that asbestos exposure and asbestos-related pleural plaques and interstitial disease are associated with (1) immune imbalances favoring helper-inducer T-cell subsets in blood and bronchoalveolar lavage (BAL) and (2) T-lymphocyte accumulation in BAL. One hundred twenty-two asbestos-exposed subsets (AES), including 27 nonsmokers (NS), were evaluated and compared with 10 unexposed normal subjects. Data were collected on medical, smoking, and occupational histories, physical examination, spirometry, lung volumes, single-breath DLCO, chest films read by a “B” reader, and T-lymphocyte characterization in blood and BAL using flow cytometry analysis of monoclonal-antibody-treated cells. On average, AES were 47 yr of age and had 23 yr of asbestos exposure. Fifty-eight (48%) had pleural thickening, and seven (6%) had profusion greater than or equal to 1/0. In blood, asbestos-exposed NS had lower total and percent CD8 and lower total CD3 than did normal subjects. In BAL, asbestos-exposed NS had higher total CD3 than did normal subjects. Among AES, increased asbestos exposure was associated with increased percent CD8 in BAL and decreases in both percent lymphocytes and total CD8 in blood. Increase in CD4/CD8 ratio in BAL were associated with pleural thickening. In those seven with profusion greater than or equal to 1/0, there was increased percent CD4 in blood and decreased percent CD8 in BAL. These results suggest immune imbalance favoring helper-inducer T-cell subsets in association with asbestos exposure systemically and with pleural plaques in BAL.”

A second study is called, “Changing attitudes and opinions regarding asbestos and cancer 1934-1965″ by Enterline PE.  Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, PA 15261.  Am J Ind Med. 1991;20(5):685-700.  Here is an excerpt: “Literature published in the years 1934-1965 was reviewed to determine attitudes and opinions of scientists as to whether asbestos is a cause of cancer. In Germany, the issue was decided in 1943 when the government decreed that lung cancer, when associated with asbestosis (of any degree), was an occupational disease. In the United States, however, there was no consensus on the issue until 1964. Opinions of scientists over a 22 year period are shown and the contributions of various cultural, social, economic and political factors to these opinions are discussed. A lack of experimental and epidemiological evidence played a major role in delaying a consensus. Other important factors included a rejection of science conducted outside of the U.S. during this period, particularly a rejection of German scientific thought during and after WWII, and a rejection of clinical evidence in favor of epidemiological investigations. Individual writers rarely changed their minds on the subject of asbestos as a cause of cancer.”

If you found any of these studies interesting, please read them in their entirety.  We all owe a great deal of thanks to the people who are researching these important issues.

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Mesothelioma, Asbestos Lung Cancer, Asbestosis, Pleural Thickening

Mesothelioma, Asbestos Lung Cancer, Asbestosis, Pleural Thickening

There are five main asbestos diseases including asbestos cancer that can develop following exposure to asbestos fibres. These are malignant asbestos mesothelioma cancer, asbestos lung cancer, asbestosis, asbestos pleural thickening and asbestos pleural plaques, however, doctors who do not regularly diagnose asbestos disease can misdiagnose (or be slow to give a diagnosis) what the condition is. This can lead to sufferers of asbestos disease wrongly concluding they do not have a right to make an asbestos compensation claim. It is therefore extremely important for sufferers of lung disease who have been exposed to asbestos fibres to immediately contact a specialist asbestos lawyer or asbestos attorney for advice and assistance in obtaining an accurate diagnosis if there is any doubt.

There are five main asbestos diseases including asbestos cancers that can develop following exposure to asbestos fibres These are malignant asbestos mesothelioma cancer, asbestos lung cancer, asbestosis, asbestos pleural thickening and asbestos pleural plaques, however,

Doctors who do not regularly diagnose asbestos disease can misdiagnose (or be slow to give a diagnosis) what the condition is because:-

A history of asbestos exposure may not be volunteered to the doctor at an early stage as it may have occurred 30, 40, 50 or even more years prior to seeing the doctor and may have been forgotten about. A striking feature of asbestos disease is this long latency period between exposure and onset of symptoms, the fibres laying dormant for many years before causing asbestos disease or symptoms for which medical advice is sought.

Some asbestos diseases require exposure to only very few asbestos fibres to cause illness, especially mesothelioma which can be caused by just one fibre being inhaled into the lungs! This adds to the above mentioned difficulty of no, or only poor, recollection of exposure to asbestos fibres and accurate diagnosis.

As chest physicians become more aware of asbestos disease, due to its increasing incidence, and the need to ask patients at an early stage if they have ever been exposed to asbestos fibres, these difficulties become less and less of an issue, however, in addition to early history taking the following further difficulties regularly arise.

The radiological evidence (shown on x-ray films) is often misunderstood. This can often lead to a incorrect diagnosis being made in asbestos disease cases of pleural plaques and pleural thickening. This is usually due to inexperience and the fact that radiological evidence of asbestos pleural plaques is similar, to the inexperienced eye, to asbestos pleural thickening and vice versa.

This is important in the context of asbestos UK disease litigation as asbestos pleural plaques is currently not considered to be an “injury” by the UK courts for which compensation can be awarded! This is in spite of the fact that pleural plaques sufferers were routinely awarded compensation for twenty years prior to a Court of Appeal ruling in 2006.

Accurate diagnosis in cases of asbestos pleural thickening can be difficult due to the fact that apart from the potential for it to be radiologically confused with pleural plaques, it can also be confused with other non-asbestos related injuries or illnesses. For example, as part of the careful history taking in cases of suspected pleural thickening, it is important to ask the patient if they have ever had a fractured rib or ribs. The healing process of a fractured rib can leave behind radiological evidence that shows up on x-rays as pleural thickening. Other prior lung complications and conditions can also leave behind such evidence.

Difficulties can also arise when trying to arrive at an accurate diagnosis in cases of asbestosis. Asbestosis is the scarring of lung tissue caused by asbestos fibres in the lungs. The difficulty here is that scarring of lung tissue can be caused by other factors or foreign bodies entering the lungs and not just asbestos fibres. Lung scarring or fibrosis appears the same on x-ray films regardless of what has caused it. It is therefore crucial, perhaps more so than with any other asbestos disease, to ensure an early and very detailed history of significant exposure to asbestos fibres is taken and recorded as lung fibrosis can only be diagnosed as asbestosis if the patient has suffered significant and heavy exposure to asbestos fibres in the past.

Nigel Askew is a specialist asbestos lawyer dedicated to helping those who suffer from asbestos related illness. For more information visit

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