Document 4JmMNoxoE57GOQNDOD3dbDX2e

'Urre noti 7o pr<f d hyfl logisf le Mil 'g croptig i aabJ ight- resenfi 3UghJ erateSj tive 1| mal I :avegffl udatejj racoti d plel i addljl ter da. t becjl e noffl lecaua usioti recoV ibvio ierve| sedt : year! \ad revea I effii was ;ti adhesjl year jj tic 1 ix. one b6 m bej > dev^T inasl? ectivejj a beejj (align iad svj founij n thd ed fpl uiosisjr d. Hejg of ,owir> beniglfi ed bYJ ind na.4 192,:$ BENIGN ASBESTOS PLEURISY--EISENSTADT 421 pc ,,,0r nowhere has the benign disease of the pleura Cognised properly. Comment /ibe pathogenesis and the pathological findings of r-gn asbestos pleurisy do not differ fundamental izm those of classical asbestosis. Mechanical irri;^n or chemical influences may affect the pleura ,eU as the lung parenchyma. Strangely enough, ,409 bodies have never been seen by us in the ral tissues. This observation, shared by the jority of the investigators/ in no way excludes restos as the causative agent. In addition, the Jden appearance of a unilateral or bilateral jlyral effusion after many years of exposure is fitte suspicious of a sensitivity response than of a feet local toxic reaction. pFhe clinical, laboratory, and x-ray picture of Ikural asbestosis does not differ significantly from Jit of any other form of pleural disease. The jfiurisy may be acute, subacute, or chronic; dry, pious, or hemorrhagic; unilateral, or bilateral. The oearance of an effusion on one side followed gorier or later by a similar one on the other seems be most characteristic of asbestosis. Streak-like lid patchy pleural calcifications on the x-ray films ||ye been known to be associated with various siliTtoses for a long time.5 Their presence may be Bjlpful in the diagnosis of asbestosis; however, they in be seen in asymptomatic patients, and are equently absent at the time of active pleuropuljohary disease. jeThe history of prolonged exposure to asbestos pst is of greatest diagnostic significance. However, |ue to the secrecy of the various manufacturing processes the use of asbestos is not always known i the workmen nor to their physicians. Insulators, JKpefitters, and boilermakers who frequently come |n contact with this material may be under suspiiioh whenever respiratory disorders develop in jfcem. Unfortunately, many workers have changed |obs long before symptoms of active asbestosis ap- ear. , In the absence of any specific laboratory test the [foal diagnosis can only be established by thoracoto my, Fibrous, hyaline and calcified plaques, and remarkable thickening of the pleura with pleural Symphysis are highly suspicious to the experienced [pathologist. However, the presence of asbestos Bodies in the pulmonary parenchyma with or with out fibrosis has been generally accepted as the final criterion of asbestos disease. |> The differential diagnosis of asbestos pleurisy has i exclude tuberculosis, which has an almost identi cal. course, and x-ray and laboratory appearance. |n addition, several other pathological entities pre|<mt a similar clinical picture and can only be languished after exploration. The old dictum, Jpdiopathic pleurisy is tuberculous unless proven gatherwise," has often prevented a correct differentilation, IfeThe prognosis of benign pleural asbestosis is generally favorable. The disease is usually self limited and disappears within a period of weeks or months. However, sometimes the course is pro longed and occasionally, as demonstrated in cases 3 and 4, it is followed by pleural malignancy. Due to its self-limited course, asbestos pleurisy requires only symptomatic therapy. In the past, the recovery of the patient has probably been erroneously attributed to antibiotics and antituber culous drugs administered because of suggestion of infectious etiology. In recurrent and chronic pleural asbestosis, steroids may be of value for the anti inflammatory and antifibrotic effect. If none of the conservative methods are successful in the pro longed cases, pleurectomy should be recommended in order to avoid the development of malignancy. At a recent conference on asbestosis of the New York Academy of Science, C. Berkley, J. Churg, W. E. Smith, and I. J. Selikoff" have been able to demonstrate isolated asbestos fibers with the help of fluorochrome tagging and after electronic ashing in tissues not containing asbestos bodies. It is hoped that these new procedures may further clari fy the pathogenesis of pleural asbestosis. We have observed cases of benign idiopathic pleurisy as well as malignant mesothelioma among the same group of asbestos workers where the diagnosis of asbestosis could not be established because of absence of as bestos bodies. Summary The clinical picture of benign asbestos pleurisy differs greatly from that of classical asbestosis. It may occur in the absence of significant pulmonary disease and respiratory dysfunction. This entity must be considered in the differential diagnosis of any form of idiopathic pleurisy. The history of ex posure to asbestos will aid in directing the attention to this entity; however, the final diagnosis depends on a lung tissue specimen containing asbestos cor puscles or asbestos fibers. E. C. McRee, MD, Port Arthur, Tex, gave permission to publish case 1. References 1. Pendergrass, E.P.: Pneumoconiosis Problem, Springfield, III.: Charles C Thomas, Publisher, 1959. 2. American College of Chest Physicians: Report of Section on Nature and Prevalence Committee on Occupational Diseases of Chest, Dis Chest 45:107-111 (Jan) 1964. 3. Eisenstadt, H.B.: Asbestos Pleurisy, Die Chest 46:78-81 (July) 1964. 4. Wagner, J.C.; Sleggs, C.A.; and Marchand, P.: Diffuse Pleural Mesothelioma and Asbestos Exposure in North Western Cape Province, Brit J Induatr Med 17:260-271 (Oct) 1960. 5. Schneider, L., and Wimpfheimer, F.: Multiple Progressive Calcific Pleural Plaque Formation, JAMA 189:328-330 (July 27) 1964. 6. Eisenstadt, M.D., and Wilson, F.W.: Primary Malignanl Mesothelioma of Pleura, J Lancet 80:511-514 (Nov) 1960. 7. Wood, W.B., and Gloyne, S.R.: Pulmonary Asbestosis: Re view of 100 Cases, Lancet 2:1383-1385 (Dec 22) 1934. 8. Ehrenhaft, J.L.: Sensenig, D.M.; and Lawrence, M.S.: Meso theliomas of Pleura, J Thorac Cardioo Surg 40:393-409 (Sept) 1960. 9. Berkley, S., et al: Detection and Localization of Mineral Fibers in Tissue, read before New York Academy of Science, Conference of Biological Effects of Asbestos, Oct 19-21, 1964. tlAMA, May 3, 1965 Vol 192, No 5 161