00:00
Now with the asbestose,
important,
lower lower
lower lobe.
00:05
Why?
Because as we go further into
other pneumoconiosis,
including silica and such,
then we will see as to how
the different parts of the lung
that are being affected
is then going to clue you in
with what's going on.
00:17
Lower lobe involvement.
00:19
The CT will show
calcified.
00:22
Well, colors calcium...
00:23
good,
white.
00:24
In fact, it's ivory white,
super diaphragmatic nodules
above the diaphragm.
00:30
That's huge.
00:31
CT of the chest.
00:33
Next, Serpentine.
00:35
Okay, so,
what does all this mean?
Well, it's important that
you pay attention to
what kind of fibers
that your patient,
in fact, got exposed to?
So if your patient was a roofer,
and is showing signs of
restricted lung disease,
and you know it's asbestos
and you've identified
on your bronchial lavage
as being your ferruginous bodies.
00:56
Well, then your next thing is
what kind of fibers were these?
Okay?
Luckily,
and I say lucky
90% of the fibers that are found
with asbestos
in the US and commercial use
is going to be
what's known as your
Chrysotile.
01:09
I would know both names,
please,
I would definitely know
both names
Serpentine (Chrysotile)
This is the one in which
it is less carcinogenic,
less carcinogenic.
01:21
But this is the major type of fiber
that you would find
a fiber pattern
that you find with asbestos.
01:26
Now we have Amphibole.
01:28
Here once again,
I would know the other name.
01:30
An Amphibole,
think of a crocodile.
01:33
Can a crocodile
live in a water?
Sure, it can.
01:36
Can crocodile live
outside of water?
Yes it can.
01:39
Is it amphibious?
Ahuh, look at the name
Amphibole.
01:42
Another name for this
is Crocidolite.
01:46
If that helps.
01:47
This is the one
that's dangerous.
01:49
This is the one that is
doesn't look like a serpent.
01:53
It's not curved and wavy.
01:55
It is straight and brittle.
01:57
This is the one that is
clinically more carcinogenic.
02:02
You tell me once again,
if your patient got
exposed to asbestos
what kind of lung cancer
are you more likely to move on to?
Good, bronchogenic.
02:09
It's a bigger family
of lung cancers.
02:12
which of all you
bronchogenic cancers.
02:14
Let me ask you.
02:15
Which of all the
bronchognic cancers
is the most common?
Adenocarcinoma.
02:21
Okay, let's continue.
02:22
Good. Alright,
so now with the asbestos
you have
benign asbestosis.
02:27
and then here we have something
called pleural effusion
type of early sign.
02:33
Okay, what does that mean?
It means that where are you
affecting your lung?
Sure, the sputum
and the ferruginous body
and he had those
free radical type of reactions.
02:43
But then
you see also those
you had this pleural plaques,
didn't you?
So now it's safe to say
that pleural plaque is not
or is not necessarily associated
with mesothelioma 0.1, 0.2
you can say that because
you have compromised of the
normal pleural protection
that you might then
develop your pleural effusions.
03:03
And that is an
early, early, early sign.
03:06
That's known as your
Benign Asbestos Pleural Effusion
B-A-P-E.
03:12
What else?
Asbestos and smoking.
03:14
Oh, my goodness.
03:16
For example, think about
some of these occupations.
03:18
And do you think that a person is a
roofer, or a plumber, and so forth?
May perhaps be smoking as well?
There's every possibility.
03:26
So now what happens?
Things are getting
a little confusing,
but, but stick
to your foundation.
03:32
Asbestos and smoking
dramatically increase the risk for
receive bronchogenic carcinoma.
03:38
Okay.
03:39
So asbestos itself.
03:41
Sure, bronchogenic.
03:42
But the combination of the two
is just going to hasten
the pathogenesis.
03:48
Asbestos is the only
only known risk factor for
Ah, that non-bronchogenic cancer
known as malignant mesothelioma.
03:57
The one that has unfortunately
become very common
on TV commercials.
04:05
However, you know,
it's the bronchogenic carcinomas
that is more common asbestos.
04:12
With the asbestos,
things that you're going to pay
attention to,
is the fact that on the chest x-ray
it is going to be the lower lobe
that's going to be affected.
04:19
Okay, so it's a lower lobe that
you're paying attention to.
04:22
On CT, what might you then
expect to find?
Good, those calcified regions
that is then known as your
ivory white type of CT findings
of calcification.
04:35
Good.
04:36
The lower lobe is what you're
seeing here is being affected.
04:38
It looks more reticular in nature.
04:40
It is the interstitium
that is being affected,
and there is fibrosis
its kicking in.
04:45
There are two major type
of fibers that we talked about
the serpentine,
which is common,
the Chrysotile,
and the one that's dangerous
is the to Amphibole
and that's the Crocidolite.