Asbestos related lung diseases

Question 1

What are some Asbestos related lung diseases?

Answer 1

Asbestosis
Lung cancer.
Mesothelioma
Pleural effusion
Pleural plaques
Thickening of the tissues around the lungs.

Question 2

What is asbestosis?

Answer 2

Asbestosis is diffuse interstitial fibrosis of the lung as a consequence of exposure to asbestos fibres.

Question 3

What are the risk factors of asbestosis?

Answer 3

> Inhaled asbestos

> Cigarette smoking

Question 4

What are the signs and symptoms of asbestosis?

Answer 4

> Dyspnoea on exertion
> cough
> Crackles
> Chest pain 
> (clubbing)

Question 5

What is the epidemiology of asbestosis?

Answer 5

In 2016 in the UK, 1050 new cases of asbestosis were assessed under the Industrial Injuries and Disablement Benefit scheme; around 1-2% of these cases were female

Question 6

What investigations would you do for asbestosis?

Answer 6

> CXR PA and lateral (lower zone linear interstitial fibrosis; progressively involves the entire lung; pleural thickening)
Pulmonary function tests (Restrictive changes, may have obstructive picture)
High res CT
Lung biopsy
Bronchial Lavage

Question 7

What is mesothelioma?

Answer 7

Malignant mesothelioma is an aggressive epithelial neoplasm arising from the lining of the lung, abdomen, pericardium, or tunica vaginalis

Question 8

What are the risk factors of mesothelioma?

Answer 8

> Asbestos
Age 60-85
Radiation
Genetics, male, simian virus 40

Question 9

What are the signs and symptoms of mesothelioma?

Answer 9

> SOB
> Diminished breath sounds
> Dullness to percussion
> Chest pain
> cough
> Constitutional symptoms

Question 10

What is the epidemiology of mesothelioma?

Answer 10

The disease is more common in men and white people, and typically occurs in older adults (sixth to ninth decade of life).

In the UK, the incidence has been increasing rapidly since the 1960s, when the mesothelioma register was established to record cases. Currently it is projected that the annual number of deaths in the UK will peak some time between the years 2011 and 2015, with 1950 to 2450 deaths.

Question 11

What investigations would you do for mesothelioma?

Answer 11

> CXR
Unilateral pleural effusion, irregular pleural thickening, reduced lung volumes, and/or parenchymal changes related to asbestos exposure (e.g., lower zone linear interstitial fibrosis)

> CT Chest and Upper abdo with IV contrast
Pleural thickening and/or discrete pleural plaques, pleural and/or pericardial effusions; enlarged hilar and/or mediastinal lymph nodes; chest wall invasion and/or spread along needle tracts can occur

Question 12

What is a pleural effusion?

Answer 12

A pleural effusion results when fluid collects between the parietal and visceral pleural surfaces of the thorax.

Question 13

What are the signs and symptoms of a pleural effusion?

Answer 13

> SOB
> Dullness to percussion
> Pleuritic chest pain
> Cough
> Quieter breath sounds
> Decreased or absent tactile fremitus

Question 14

What are the risk factors of a pleural effusion?

Answer 14

> CHF
Pneumonia
Malignancy
Recent CABG

Question 15

What is the epidemiology of pleural effusions?

Answer 15

About 1.5 million people develop a pleural effusion in the US each year.

Question 16

What investigations would you do for pleural effusions?

Answer 16

For Infection
CXR
Bloods- FBC, CRP
Pleural fluid- cytology, culture, pH, glucose and cholesterol, WBC, RBC
Sputum Gram stain and culture

For Cardiac Causes
CXR
N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in pleural fluid
LDH and protein in pleural fluid and serum

For Malignancy
Bloods
Pleural fluid- pH, glucose and cholesterol, WBC, RBC