Document NNy7XYraRg0MaNXJJ1dxk19rD

SM-Ii (REV S-7SI Shell Oil Company Interoffice Memorandum FEBRUARY 13, 1990 TO: DR. ROBERT HUGHES, DEER PARK MANUFACTURING COMPLEX, MEDICAL DEPARTMENT FROM: LOUIS C. WADDELL, JR., M.D. SUBJECT: PULMONARY REGISTRY REVIEW, EMPLOYEE This case is reviewed because of a possible pleural plaque. His job classification is "material controller". He is in the Asbestos Surveillance Program. His chest X-ray was interpreted by a radiologist. Dr. M. A. Mullican on 04/21/88 using the ILO system. That classification indicated no parenchymal abnormalities thought to be consistent with pneumoconiosis. However, there were pleural changes classified as circumscribed changes bilaterally of width A and extent 1. Pleural calcification was also described on the right side of extent 1. The calcification is in a distinctly unusual area for asbestos exposure related radiographic findings. The area of concern is a small linear presumably calcified area at the right apex. Dr. Mullican also describes "a localized convexity along the right diaphragm which could be a non-calcified pleural plaque or possibly a normal variation". The chest X-rays have also been interpreted by Dr. Patrick M. Conoley, a NIOSH certified B-reader radiologist. On his film report dated 09/24/87 he says'" the following concerning four-way views of the chest dated 09/14/87 as well as X-rays dated 09/22/87, "There is a minimal, focal convexity to the right hemidiaphragm of indeterminate significance. There is minimal widening of the pleural stripe along the lateral thoracic wall without evidence of calcification. There is a short calcific linear? change at the right pulmonary apex. I do not see evidence of pleuraIf thickening at this site. It is basically stable in appearance since 1982. This may represent a atherosclerotic pleural in the subclavian artery but I could not exclude the possibility of focal, linear, calcified pleural calcified plaques. No other significant change is noted to suggest pleuraparenchymal asbestosis." Although there is a check mark on the pulmonary registry form indicating possible fibrosis, all film readers including this consultant feel that the lung parenchymal is clear and there is no radiographic evidence of interstitial fibrosis. There is a slight reduction in the percent predicted forced vital capacity to 78% but there is a greater reduction CA9003801 - 0001.0.0 ABS-055356 LAM 031963 in the percent of predicted of the FEV1 to 70%, all of which suggest an obstructive rather than restrictive ventilatory impairment. I have also had the opportunity to review the chest X-rays. I agree with the film interpretations of the two radiologists both of whom agree essentially in their ILO classification. The changes are certainly consistent with the pleural findings associated with asbestos exposure. It should be noted that apical pleural changes are distinctly unusual findings in an asbestos exposure person. Personally, I have seen over 3,000 chest X-ray of employees who are in asbestos surveillance programs and I have not seen any cases of calcified pleural plaques in the apex. However, the lateral wall changes are consistent with asbestos exposure and the area along the right diaphragm is consistent with a diaphragmatic pleural plaque. Because he is in an asbestos surveillance program with its presumption of previous occupa tional exposure to asbestos and because the radiographic changes are consistent with pleural plaques, I would suggest that he be considered a pleural plaque case both for purposes of recording on the OSHA 200 log and for counseling the employee concerning the chest X-ray and the implications of those changes. Accordingly, it would be my opinion that the case should be recorded on the OSHA 200 log as a "bilateral pleural plaque" case. If you have any questions please give me a call. Thank you for your cooperation in handling these cases. CA9003801 - 0002.0.0 ABS-055357 LAM 031964 S-13290 (V&9) 006051 NAME OF EMPLOYEE PULMONARY REGISTRY CONFIDENTIAL - MEDICAL 1 EMPLOYEE NUMBER ! LOCATION i>fp h &. REASON FOR REVIEW 1. CHEST X-RAY REPORT INDICATING: a) Possible pleural abnormality TyT b) Possible fibrosis ' Fn* * 2. PULMONARY FUNCTION TEST ABNORMALITY: a) PVT. Ipqc rtvin 75% of prfvliriPrt _________ 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 y],--, 1 1 YES NO 8. PLEASE LIST JOB TITLES AND NO. OF YEARS IN THAT POSITION n hj Other . Other reason for review 9. Is mere any history of other respiratory illness that could account lor me X-ray abnormalities under consideration? If so. list .^| |vcc 1--2 1__ 1 Tti5 1 -n* ss? wt-2- 5. Has the employee worked In a facility that used asbestos so that It Is possible that a pleural plaque could be related to J06 exposure? 6. Has me employee worked at a job (e.g., bricklayer, insulator, etc.) lor a sufficient time (usually at least to years) lor It to be likely that asbestosis could have developed? (a -t' >f mo/p<jo y'1-- 1--1 It/) YES | | 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 / \L SlfTTvcc I--1 Ytb 1__ INU ywO,--, .--, ^ YES -- --1 RESULT OF REVIEW: mx toad- Ck&tf Hi/As^rC- Grtkfrejj 4U10I fifties cu*. Recommendavon: i_ " 1^-J-tysL U^// PUaJ^^ ^ Pr n 'lots Ua Jfof ^ A//W-*** f/faistr/' " yf NOTE: (check list of actions to be completed by the/Company doctor and _ returned to registry in Houston, with one copy to be retained in employee's chart) ^-t/pLEURAL CHANGE D^TE IF POSSIBLE FIBROSIS DATE Patient counseled: OSHA Form 200: Worker's Compensation: { M2, {] ' A // ?s ' / Ai/r? (' ? Patient counseled: OSHA Form 200: Worker's Compensation: ------ ... .... EMPLOYEE REFERRED TO DR. (Phase send copy of consultation when available) COMMENTS: Ti -f-3 OTS; NAAAM<E />! ^-I 1 ___ _ A Vc- ABS-055358 CONTEMPLATED FOLLOW-UP fc^fPERK30IC EXAM | | OTHER LAM 031965 S-12972 (11-86) ILO PULMONARY SURVEILLANCE WORKSHEET L (~u) 1 CLINICAL INTERPRETATION 2. B-READING COMMENTS There are believed to be bilateral calcified diaphragmatic plaques, The chest x-ray is otherwise unrem; rkable and little interval change is apparent since 1-23-89. ABS-055359 PLEASE TYPE OR PRINT NAME Of PHYS`C*AN L.r- aooress tniHirhnrnrtrno, aM* .Un. // Dr<. MA . tn--1 uf _i - MO SHELL OIL COMPANY, P. 0. BOX ICO orwAT^^B^.K, TEXAS 7703b PHYSICIAN S SiGf^ATURE SIGNEO . *OATE SIGNED * t, 4-w Ao '' LAM 031966