Document dnXVpLzZX6w97K53Qbmy0NOnQ

SM-32 (REV 5-76) Shell Oil Company Interoffice Memorandum JULY 18, 1990 FROM: L. C. WADDELL, JR., M.D. TO: DR. ROBERT HUGHES - DEER PARK MANUFACTURING COMPLEX SUBJECT: PULMONARY REGISTRY REVIEW - EMPL This case is reviewed because of possible pleural plaques. There are several areas on chest x-ray that are suspicious of pleural plaques. The first area that was noted on the chest x-ray is an area of apparent soft tissue thickening in the right lower lung field. As early as 1984 there was some diagnostic effort expended concerning that shadow. This led to a pulmonary consultation from Dr. Brian Walker, a pulmonary disease consultant at that time at the Kelsey-Seybold Clinic in Houston. Dr. Walker indicated that the review of the chest x-ray showed some possible shadows in that area as early as 1981 but was clearly seen on the film in 1983. A CT scan of the chest showed a small, wide-based pleural mass of low density without calcium. Dr. Tucker said the etiology of this is "possibly a benign mesothelioma or perhaps (old traumatic area of) scar tissue." Over the years, this shadow has persisted essentially unchanged. There are also several apparent pleural based shadows noted on the chest x-rayin the left chest. On the chest x-ray dated 2/1/88, between the 7th and 8th posterior ribs and between the 8th and 9th left posterior ribs there are two shadows which run essentially parallel to each other running tangentially across the chest wall. Superior and medial to the lower of the two shadows is a small shadow inferior to the rib margin. Most recently (chest x-ray dated 5/24/90), a small area of linear calcifica tion approximately 4mm in length has been described which is consistent with an area of diaphragmatic pleural calcification of the type that can be seen from exposure to asbestos. A detailed occupational exposure history is down in the chart which was done by Mr. R. E. Evans on 5/24/90, which indicated that during : employment at Shell he did have opportunity for at least bystander type occupational exposure to asbestos. In summary, this is a retired Shell refinery employee who does have a past history of occupational exposure to asbestos and whose chest x-ray CF9019902 - 0001.0.0 LAM 032216 shows bilateral changes which are consistent with the type pleural reactions that can occur from inhaled asbestos fibers. Accordingly, this case should be considered as a pleural plaque case both for purposes of counselling, which he probably has already received, and for purposes of OSHA 200 Log recording. We are returning along with pulmonary registry form with the appropriate portions the for the OSHA 200 Log entry. this consultation report a copy of the our portion completed. Please indicate in date of counselling and the date of entry Thank you for sending us this information for our review. If you have questions, please aive me a call. Enelosures CF9019902 - 0002.0.0 ABS-055610 LAM 032217 INSTRUCTIONS: PART 1 - WHITE COPY - LOCATION MEDICAL DEPARTMENT LAM 032218 S-12972 (1I -86) r^ 'I ILO PULMONmRY surveillance worksheet EMPLOYEE NAME (First. Middle. Last) COMPANY r--j SHELL [1 OIL COMPANY 1(--1 SHELL CH6M --1 COMPANY 1j--| SHELL DEV. --1 COMPANY EMPLOYEE NUMBER DATE OF X-RAY READING //- / -?> OTHER TYPE OF EXAMINATION 1 n|--] 1-- (*(>*CI,Y)--------------- ----------------------------------------- --3 ASBESTOS SiLiCA OTHER j ] csceo/vi 1 A. DATE OF X-RAY MONTH OAT I ,o sHoi IB. FILM QUALITY | i | 2 1 3 1u/r| 2A. ANY PARENCHYMAL ABNORMALITIES CONSISTENT WITH PNEUMOCONIOSIS? 28 SMALL OPACITIES a SHAPE/SIZE SECONDARY II Not Grade 1 Give Reason 1C IS FILM COMPLETELY NEGATIVE? YES Q Proceed to Section 5 NO(J SP reocctieoend2to YES COMPLETE 28 and 2C NO PROCEED TO SECTION 3 c. PROFUSION %% % '/o '/2 V. V2 V* y3 3A 2C. LARGE OPACITIES SIZE EO A B PROCEED TO SECTION 3 3A ANY PLEURAL ABNORMALITIES CONSISTENT WITH PNEUMOCONIOSIS? 38. PLEURAL THICKENING a DIAPHRAGM (plaque) 3C PLEURAL THICKENING a CIRCUMSCRIBED (plaque) ^ES Q COMPLETE 3B. 3C and 30 Chest Wail no PROCEED "O SECTiON a SITE O I R L b COSTOPHRENIC ANGLE SITE | O | R | l ] 3D PLEURAL CALCIFICATION SHE IN PROFILE i WIDTH n EXTENT FACE ON EXTENT 0R oA s c l ' 3 0L o A|8 C 0 1 i2 3 0I 1 I2 I3: SITE IN PROFILE . WIDTH -i EXTENT FACE ON ii. extent 0R o Aj3 C 0 l|2 3 T? 0 | l. OA 3; ' 3C ?: 2 c l. i CL SITE WALL other sites 0R Extent 0! 23 0i23 0 Ll 2 3 b wall . c other sites L XTENT 10 1 ( 2i 3 0` , i 2 i 2 0 1 2| 3 DCEED '0 :t.gn i 4A ANY OTHER ABNORMALITIES? 4B OTHER SYMBOLS (OBLIGATORY) YES Q complete 43 and 40 NO PROCEED TO SEC * 'On 5 L a* ! bu j ca cn 1 CO CP ! c l c. 1 e!>m 1 e$ j *r n. | ho d in Report ite^is which rr,ay ce ol present cimicai smit.cance in this sect.on [SPECIFY od i " p. px | o 1 m 1 Date Personal Dhivs,c;an nc;.f r:0 1 CLINICAL INTERPRETATION 2 B-READING COMMENTS I DO NOT SEE ANY EVIDENCE OF PNEUMO< :ONIOSIS NOR ANY' OTHER SIGNIFICANT ABNORMALITY. LITTLE INTERVAL CHANGI IS NOTED SINCE 9-27-88. , PLEASE TYPE OR PRINT NA`.S,Ht5PPER, M.D./A. J. THOMANU, M.D. SHtLL OIL COMPANY p n rny im AOtDEER PARK, TEXAS 77536 CITY/STATE/ZIP COOE ! PHYSICIAN'S SIGNATURE ____ JiLLi ( . ,W \l`V l 1 ylo^'/UuJJU 'c SIGNED , 1 ^_ //' / -fD DATE SIGNED ABb-ObOolL INSTRUCTIONS: WHITE COPY - FOR CORPORATE MEDICAL DEPARTMENT LAM 032219