Document 1gzKMp590gBqd9aROQ1xa9gEj

iM-32 (REV. 5-T9) Shell Oil Company Interoffice Memorandum MARCH 26, 1990 FROM: L. C. WADDELL, JR., M.D. TO: DR. ROBERT HUGHES - DEER PARK MANUFACTURING COMPLEX, MEDICAL DEPARTMENT SUBJECT: PULMONARY REGISTRY REVIEW - This case is reviewed because of possible Dleural changes. The chest x-rays have been reviewed by a NIOSH-certified B reader radiologist, whose chest x-ray report dated 8/8/88 described a type 1 pleural thickening on the right chest. There is also mention in the clinical interpretation portion of the B reader comments of the form "there is a calcified plaque in the aortic arch. This, of course, refers to a vascular plaque and not a pleural plaque. Concerning the right lateral wall changes, there are very subtle, minimal pleural or extrapleural shadows noted in the right lateral chest wall which are most compatible with a so-called companion shadow. However, it is also important to note that these changes were present on the earliest film that we have which was in 1977. According to Dr. Patrick M. Conley, also a^8 reader radiologist, who interpreted the chest x-ray serially. On a film report dated 6/19/87, he indicated that over the 10-year time interval for those films there were no progressive changes involving the costopleural area. This indicates that even if this is a pleural plaque that it was present at the time he joined employment at Shell. It is my opinion, however, that this right-sided shadow is probably a companion shadow rather than a silicade exposure-related pleural plaque. For purposes of the OSHA 200 Log at Shell, I do not believe that we need to consider this a pleural plaque. However, if the employee has not been informed that there may be a pleural plaque on his chest x-ray and counselled about the implications of that, then he should be. I would suggest that he be told there is a possible pleural plaque on his chest x-ray but this could well be a normal shadow, and in any-event it was present on the 1977 chest x-ray. LAM 032087 ABS-055480 I We are returning along with this consultation report a copy of the pulmonary registry file. Thanks for your cooperation. If you have any questions, please call. CF9006802 - 0001.1.0 LAM 032088 ABS-055481' 1 0s0-8ia0a61gofVM) PULMONARY REGISTRY CONFIDENTIAL - MEDICAL REASON FOR REVIEW t. CHEST X-RAY REPORT INDICATING: a) Possible pleural abnormality_______ b) Possible fibrosis. 2. PULMONARY FUNCTION TEST ABNORMAUTY: a) FVC less than 75% of predicted_____________ b) Other . Other reason for review 7. Has the employee had a job where It Is possible, or likely, that he has been exposed to some other agent known to cause a dust disease of the lung, (e.g., Silica, etc.)? If so, list ,--, .--, ^ I I YES lAWO -- 1--1 8. PLEASE JJST JOB TITLES AND NO. OF YEARS IN THAT POSITION --ifyrf lh~-------------------------------------------- 9. Is there any history of other respiratory Illness that could account for me X-ray abnormalities under consideration? If so, list i | ,,,, i I 1 Ytb |<no Time of service 5. Has the employee worked In a facility that used asbestos so that it Is possible that a pleural plaque could be related to joo exposure? 6. Has the employee worked at a job (e.g., bricklayer, insulator, etc.) lor a sufficient time (usually at least 10 years) for it to be likely that asbestosis could have developed? _____________________________ 0<esQ NO 10. Is there a history of exposure to a pneumoconiosis producing agent outside of employment at Shell {prior to working at Shell or associated with a parttime job, or avocation)? If so, list YES Q NO RESULT OF REVIEW,^ fiP ReUj&cCrl- Qyes Qno r< CmUinrh .ril&U P&f Patient counseled: OSHA Form 200: I InAVm Jr_ Worker's Compensation: EMPLOYEE REFERRED TO DR. (Please send copy of consultation when available) COMMENTS: on^re 1 Prv- h* NMOOTTE: (chheecckklHisst oof actions to be completed by the Company doctor ana returned to registry In Houston, with one copy to be retained in employees chart)________________ IF POSSIBLE FIBROSIS DATE Patient counseled: OSHA Form 200: Worker's Compensation: r n CONTEMPLATED FOLLOW-UP ABS-055482 Z- PERIOOIC EXAM | | OTHER INSTRUCTIONS: PART 1 - WHITE COPY - LOCATION MEDICAL DEPARTMENT LAM 032089 S-12972 (11-66) ILO PULMONARY SURVEILLANCE WORKSHEET EMPLOYEE NAME <first Middle, Lest) COMPANY SHELL OIL COMPANY f--| SHELL CHEM. r-, SHELL DEV. 1--1 COMPANY LJ COMPANY OTHER |--"l .. I__ I ISpecify)- EMPLOYEE NUMBER date of x-ray reaoing (TYPE OF EXAMINATION -| Eg ASBESTOS SILICA 11-30-89 OTHER (Sped,), A. DATE OF X-RAY i,/1 w> I IB. FILM QUALITY 2A. ANY PARENCHYMAL ABNORMALITIES CONSISTENT WITH PNEUMOCONIOSIS? 2B. SMALL OPACITIES a. SHAPE/SIZE PRIMARY SECONOAflY fi L ll Not Grade 1 Give Reason: 1C. IS FILM COMPLETELY NEGATIVE? YES Proceed to Section 5 NO iSrf toProc*** Section 2 YES I I complete I--1 2B and 2C NO 0 PROCEED TO SECTION 3 c. PROFUSION V- Vo V. 7o V, 7i V. Vi Vo v2 Vi V 2C. LARGE OPACITIES SIZE I O A 8 I C PROCEED TO SECTION 3 3A. ANY PLEURAL ABNORMALITIES CONSISTENT WITH PNEUMOCONIOSIS? 0YES COMPLETE 36. 3C and 30 3B. PLEURAL THICKENING a. DIAPHRAGM (plaque) 3C. PLEURAL THICKENING . . . Chest Wall a CIRCUMSCRIBED (plaque) NO Q PROCEEO TO SECTION 4 033SITE b COSTOPHRENIC A4NGLE SITE /@0 30. PLEURAL CALCIFICATION SITE IN PROFILE i. WIOTH ii. EXTENT FACE ON m EXTENT *R 'o A 0 C 01 23 XL 0A aC 01 23 a DIAPHRAGM .. b WALL .............. c. OTHER SITES XO EXTENT 0 1 X3 y 1 12 3 L 1 2 3 SITE IN PROFILE i. WIOTH ii. EXTENT FACE ON iii. EXTENT AR oA BC 01 23 Et 2 CD O *L fe A 0' 2I3 0 12 3 1 a. OIAPHRAGM ... b. WALL .............. c OTHER SITES yO EXTENT y0 t 3 x1 2 3 1 23 PROCEEO TO SECTION 4 4A. ANY OTHER ABNORMALITIES? 4B. OTHER SYMBOLS (OBLIGATORY) YES ? NO PROCEEO TO SECTION 5 El T Report items which may be of present clinical significance m this section bo I ca I cn j co cp cv j di r- i (SPECIFY Od.) II e( | em es w: I ho I t<3 j th I kl px rp tb Date Personal Physician notified9 MONTH ____ !_____ OAY I 1. CLINICAL INTERPRETATION 2. 8-READING COMMENTS There are bilateral calcified diap iragmatic plaques. The chest x-ray is otherwise unremarkable and rela :ively unchanged since 11-30-84. PLEASE TYPE OR PRINT NAME OF PHYSICIAN c cL-cpL'3 */; Q. / R. A. HUGHEb, M-D. *00vz--_' ./ .v.pARiY, ?. 0. SO A 100 ___________ iciTY/sTjjjE/zippqoe.A.--., _a.-vo ----} :nc >> PHYSICIAN'S SIGNATURE A> SIGNEO //-*-// f _ " oAiesiGNeo / ABS-055483 INSTRUCTIONS: WHITE COPY - FOR CORPORATE MEDICAL DEPARTMENT LAM 032090