Asbestos-related lung disease

Question 1

Define asbestosis and mesothelioma

Answer 1

Mesothelioma = aggressive epithelial neoplasm arising from the lining of the lung, abdomen, pericardium or tunica vaginalis (mesothelial cells)

Asbestosis = diffuse interstitial fibrosis due to asbestos fibres lodging in alveoli

Question 2

What is the aetiology and risk factors of Mesothelioma?

Answer 2

ASBESTOS = chief causative agent (80%)

• Mining, ship building, cement manufacture, ceramics, construction workers, vehicle brake mechanic
• Dose-response relationship
• Latency period: 20-40 years

Other possible aetiologies
o Radiotherapy exposure
o Genetic predisposition (BAP1 gene mutation)
o Simian virus

Risk factors
•	Asbestos exposure
•	Male, aged 60-85
•	Radiation exposure
•	FH

Question 3

What are the risk factors for asbestosis?

Answer 3

• Asbestos – occupation
• Male
• Smoking

Question 4

Summarise the epidemiology of asbestosis and mesothelioma

Answer 4

More common in men
Occupational exposure
Peak incidence of 35-45 years after asbestos exposure
Increasing incidence rapidly since 1960s

Question 5

Recognise the presenting symptoms of asbestosis and mesothelioma

Answer 5

MESOTHELIOMA
• SOB - Increasing (typically due to large pleural effusion)
• Chest pain - Non-pleuritic or pleuritic
• Cough - Usually dry, non-productive
• FLAWS

ASBESTOSIS
• SOB – on exertion initially
• Dry cough

Question 6

Recognise the signs of asbestosis and mesothelioma on physical examination

Answer 6

• Auscultation – pleural effusion
o Diminished breath sounds
o Dullness to percussion

ASBESTOSIS
• Basal crackles
• Clubbing

Question 7

Identify appropriate investigations for mesothelioma

Answer 7

Obs

Bloods

CXR - Unilateral pleural effusion, Irregular pleural thickening, Parenchymal changes related to asbestos exposure (LZ linear interstitial fibrosis)

Chest CT - Pleural thickening, Pulmonary fibrosis, Discrete pleural plaques, Pleural/pericardial effusions, Enlarged lymph nodes

Thoracentesis - Exudate, Malignant cells in pleural fluid

VATS + Pleural biopsy

MRI

PET

Question 8

Identify appropriate investigations for asbestosis

Answer 8

CXR – 1st line
o	Excessive whiteness in lung tissue
o	Interstitial fibrosis
o	Severe: honeycomb appearance
o	Diffuse pleural thickening
o	Benign pleural effusions

Lung biopsy – GS diagnosis

Bronchial lavage – asbestos bodies