Asbestosis: Diagnosis & Treatment

by Carlo Raj, MD

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    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.

    About the Lecture

    The lecture Asbestosis: Diagnosis & Treatment by Carlo Raj, MD is from the course Occupational Lung Diseases.

    Included Quiz Questions

    1. Electronics manufacturer
    2. Shipbuilder
    3. Brake-lining mechanic
    4. Plumber
    5. Roofer
    1. Alveolar sputum sample obtained by bronchoalveolar lavage.
    2. Chest computed tomography
    3. Bronchoscopy with transbronchial biopsy.
    4. Computed tomography-guided percutaneous lung biopsy.
    5. Chest radiograph
    1. Prussian blue stain
    2. H & E stain
    3. Acid-fast stain
    4. Periodic acid-Schiff stain
    5. Congo red stain
    1. Pleural plaques
    2. Bronchogenic carcinoma
    3. Hemosiderin-laden macrophages
    4. Non-caseating granuloma
    5. Ferruginous bodies
    1. Golden brown fusiform rods with H&E stain.
    2. Cystic dilatation of air spaces lined with a columnar type of epithelium.
    3. Dense eosinophilic deposits of collagen without architectural distortion.
    4. Hyaline membrane formation and fibrin deposits lining the alveolar body.
    5. Intranuclear eosinophilic inclusion body
    1. Bronchogenic cancer
    2. Melanoma
    3. Oat cell carcinoma
    4. Squamous cell carcinoma
    5. Lymphoma
    1. It involves the upper lobes of the lungs.
    2. It involves the lower lobes of the lungs.
    3. Chrysotile fibers are the major type.
    4. Amphibole fibers are the toxic type.
    5. Calcified nodules in the supradiaphragmatic area.
    1. Asbestosis is the only known risk factor for malignant mesothelioma.
    2. Malignant mesothelioma is the most common type of malignancy associated with asbestosis.
    3. It generally affects the upper region of the lungs.
    4. It is more commonly associated with alcoholism.
    5. Pleural plaques are common precursors in the development of mesothelioma.
    1. Bronchogenic carcinoma
    2. Squamous cell carcinoma
    3. Small cell carcinoma
    4. Mesothelioma
    5. Oat cell carcinoma

    Author of lecture Asbestosis: Diagnosis & Treatment

     Carlo Raj, MD

    Carlo Raj, MD

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