Document Ne93mRxDwBpwZ46JyX13npoaE

420 BENIGN ASBESTOS PLEURISY--EISENSTADT ly, extensive destruction of lung tissue leads to respiratory and cardiac failure. It is well known that pleural abnormalities are commonly found in asbestosis. Most experts believe that they are associated only with advanced pul monary disease; others describe them as secondary complications or even as coincidental lesions not directly connected with asbestos inhalation." In contrast to these observations we have been able to find a small number of patients with asbestosis who present primarily the clinical picture of pleurisy in the absence of any significant pul monary disease or respiratory dysfunction. 1. Benign pleural asbestosis (case 2). 2. Malignant mesothelioma of pleura producing rib destruction. Note pleural calcifications. ,V- *&ff| Report of Cases Case l.3--In September 1960, a 54-year-old insulator itt| contact with asbestos for 15 years suffered from a left.-f sided pleurisy. His chest x-ray revealed a small effusi0)^ Because he had little discomfort, no thoracentesis w done, and he was treated conservatively. However, in March 1961, a similar attack occurred 0ni the right side. At this time, chest pain, cough, malaise andl fever were quite severe, and a friction rub was noted. thoracentesis yielded 500 cc serous fluid with 4% proteinf and many lymphocytes; however, neither malignant celial nor microorganisms were encountered. The course was pt04j longed, and finally an exploratory thoracotomy was donaii The visceral pleura was as thick as an orange peel, and the| pleural cavity was partly obliterated. Fibrous and hyaline* plaques covered the parietal pleura. The pathologist de-a scribed large deposits of dense connective tissue in the! pleura with inflammatory cell infiltration. A lung sections revealed thickening of the alveolar walls with macrophages! and asbestos bodies. Case 2.--A 58-year-old white male, working with asbestos! for 12 years was seen in consultation because of right-sidejn pleural effusion (Fig 1). The disease had been present fowj three weeks and had caused chest pain, fever, cough, and] dyspnea. Asbestos bodies in the sputum, a moderate lei3 kocytosis, a fast sedimentation rate, and a positive latex, test for rheumatoid arthritis were the only abnormal labofl ratory findings. Tests for tuberculosis and fungi gave nega-3 tive results. A total of 30 cc of a blood-tinged exudate wan removed by thoracentesis. Two weeks later a thoracotomy? clone because of persistent symptoms, revealed pleuratf plaques and adhesions. A lungspecimen, taken in additions to the pleural biopsy, showed asbestos bodies. After decors* tication and partial pleurectomy, the patient becamif asymptomatic, and results of his chest x-ray were normall Eight months later the patient was seen again because Ml fever and chest pain due to a left-sided pleural effusion. H| was treated symptomatically and had completely recavereq one month later. Two cases of malignant mesothelioma, obvious^ preceded by benign pleurisy, have been observed.^ CASE 3.--A 57-year-old refinery foreman,3 exposed to i bestos for a decade, was treated intermittently 12 years fa a severe pain in the hemithorax on the left. He had no al^ normal findings. One day, a routine chest x-ray revealed! spontaneous pneumothorax with a small pleural effusiqra Because of persistent symptoms a thoracotomy was dorjg which showed pleural thickening, plaques, and adhesionj The correct diagnosis was not established until a year latijl when, during a barium x-ray of the colon, osteolytic lesl0S( were discovered in the left lower side of the thorax. At tTM time, malignant mesothelioma was found in the bone SPM men. The patient obviously had suffered from beni|J pleural asbestosis for about 12 years before the develol ment of his malignancy. This case was unusual inasmutf as a spontaneous pneumothorax was the first objective eVI dence of disease. This complication is rare but has been ffl ported in association with benign 7 as well as malignant| asbestosis. Case 4.--In 1959, a 58-year-old foreman " who had supaj vised asbestos insulation for three decades was found-.B have a malignant mesothelioma of the pleura on the.ls side. Ten years earlier he had been hospitalized fi; 1 lateral pleural effusions. The diagnosis of tuberculosis W|1 entertained at this time but could never be proved. He b J been under constant medical supervision because of the7? pearance of streak-like pleural calcification following?! attack of pleurisy (Fig 2). His autopsy showed benign, bestosis in all portions of the pleura not involved by 4? malignancy. Similar case histories have been found in?Sj literature dealing with asbestos and mesothelioma. -`lia b< pie ; freq mot T dus due proc to ti pipe ' in o cion ; then jobs pear In final my. a rer symj path' bodit out f |l critei Th K. to ex. cal c. (In ad , sent . distin ` "idioj other ation. Th, 160 JAMA, May 3, 1965 Vol 192, !f|| feJAMA,