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In the name of GOD

In the name of GOD. Asbestos-Related Disease. Asbestos Exposure General. Salts of salicic acid 90% of asbestos in USA is white asbestos (chrysotile) Occurs in : Automotive workers-brake linings Shipfitters Construction workers. Asbestos-Related Disease Types of Fibers.

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In the name of GOD

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  1. In the name ofGOD

  2. Asbestos-Related Disease

  3. Asbestos ExposureGeneral • Salts of salicic acid • 90% of asbestos in USA is white asbestos (chrysotile) • Occurs in : • Automotive workers-brake linings • Shipfitters • Construction workers

  4. Asbestos-Related DiseaseTypes of Fibers • Chrysotile (white asbestos)–benign • Crocidolite (blue/black asbestos) in South Africa/Australia–malignant • Crocidolite-small fibers-associated with most pleural disease

  5. Asbestos-Related DiseaseTypes of Fibers: Serpentins Chrysotil (white asbestos) Amphibole Crocidolith (blue) Amozith (brown) Anthophylith Tremolith

  6. Asbestos-Related Disease Pathophysiology Asbestos particles invoke a hemorrhagic response in lung Fibers then coated with a ferritin-like material resulting in ferruginous bodies Damage to respiratory bronchioles and alveoli

  7. Asbestos-Related DiseaseTypes of Asbestos-related Pleural Disease Asbestosis Asbestos-related Malignancies

  8. Asbestosis (pulmonary parenchymal fibrosis) 1- Almost always involves lower lobes at subpleural areas 2-As the disease progresses, fibrosis and volume loss ensue 3-Honey-combing in lower lobe subpleural areas 4-Tracheobronchial nodal involvement is unusual 5-PMF is very uncommon

  9. Asbestos-Related Pleural Disease Pleural plaques Diffuse pleural thickening Pleural calcification Pleural Effusion

  10. Asbestos-Related Pleural DiseaseIncidence of Pleural Disease • Almost all have some pleural involvement • Pleural plaque 65% • Diffuse pleural thickening 17% • Calcification 50% • Effusion 21% Pleural involvement without parenchymal disease is common

  11. Asbestos-Related Pleural Disease Pleural Plaques-1 • Affects submesothelial layer of parietal pleura • Bilateral, mid-lung zone • Between 7th and 10th ribs • Diaphragmatic pleura • Spares apices

  12. Asbestos-Related Pleural DiseasePleural Plaques-2 Plaques don’t usually calcify Plaques alone are not associated with malignancy Appear either in “profile” or “en face”

  13. Asbestos-Related Pleural DiseaseDiffuse Pleural Thickening-1 • Diffuse thickening of parietal pleura • Involves diaphragmatic pleura, extends up lateral chest wall • Commonly obliterates costophrenic angles • Spares apices of lungs • DDX from TB

  14. Asbestos-Related Pleural DiseaseDiffuse Pleural Thickening-2 Frequently the sequela of benign pleural effusion Associated with rounded atelectasis

  15. Rounded Atelectasis Part of peripheral parenchyma invaginated into the penetrating fibrotic visceral pleura, so that part of the parenchyma is entrapped and becomes atelectatic

  16. HRCT findings of Rounded Atelectasis 1-Continuing with areas of diffuse pleural thickening 2-Lenticular or wedge-shaped 3-Comet-tail sign 4-evidence of volume loss in the affected lobe often associated with hyperlucency of the adjuscent lobe

  17. Asbestos-Related Pleural Disease Pleural Effusion • Effusion alone may occur early in disease (first 15 years) in about 3% of cases • Exudative • May be associated with chest pain • Involves visceral pleura as well • Does not mean mesothelioma • May be associated with rounded atelectasis

  18. Diagnostic Criteria: 1-Exposure history for asbestos 2- Ruling out other causes 3-Failing to detect tumor in a 3 years follow-up

  19. Pathological description: Chronic fibrinous pleuritis with low cellularity Prognosis: Good with a self-limited course Recurrence may occur

  20. AsbestosisGeneral Reserved for parenchymal lung disease Fibrosis begins around bronchi and progresses outward

  21. Asbestosis Interstitial lung disease Rounded atelectasis

  22. AsbestosisLocation More common in lower lungs More common subpleural

  23. AsbestosisX-ray • Opacities are small and irregularly shaped • Not rounded as in silicosis • Prominent septal lines around 2° lobules • Cardiac silhouette may become shaggy • Hilar lymph nodes rarely affected • DDx from silicosis

  24. AsbestosisHRCT Multiple subpleural dot-like nodularities=subpleural lines Fibrous bands Subpleural pulmonary arcades Honeycombing Thickened interlobular lines Ground-glass appearance

  25. Asbestos-Related Malignancies • Bronchogenic carcinoma • Mesothelioma • Benign • Malignant • Carcinoma of the larynx or stomach

  26. Asbestos-Related DiseaseLung Cancer • Either squamous cell or adenocarcinoma • Bronchogenic ca is almost always associated with cigarette smoking • 90x more common in smokers, 5x more common in • Frequently at lung base • Associated with increased risk of stomach cancer non-smokers

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