Asbestosis: Introduction

by Carlo Raj, MD

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    00:01 Let's take a look at our first pneumoconiosis.

    00:04 Our first pneumoconiosis here will be asbestos.

    00:07 We'll talk about the various exposure that your patient has perhaps had.

    00:12 And these exposures include: well, current day practice, and patients most likely, maybe building a house.

    00:20 And so therefore, these are your roofers.

    00:22 During the process of building a house, there has to be plumbing that has to put in.

    00:28 Insulation, building a house.

    00:29 So in general, give yourself a house in which you're building and which your patient is been working on different aspects of it.

    00:38 Maybe a plumber, maybe a roofer, maybe a person is putting in insulation.

    00:43 In addition, I told you about mechanic.

    00:45 A mechanic who is working with brake lining, or you might have heard of shipbuilding.

    00:50 So therefore, working in a Naval Shipyard.

    00:53 So there's quite a bit of...

    00:54 even in current day era, where for the most part, we're quite careful about our patients being exposed to asbestos could very well occur.

    01:04 It's absolutely possible ladies and gentlemen, as you know, to completely prevent the exposure to various chemicals, but at least you'll be able to educate your patient and understand as to where and how they're living you might be able to save quite a bit of grief.

    01:22 Okay, so now that you have asbestos, that would be occupational.

    01:26 What about non-occupational airborne? Well, what if there is a renovation? Renovation of what? A demolished asbestos building.

    01:35 So that occurs quite a bit.

    01:38 And we have old buildings that are being demolished.

    01:41 So look for these teams, right.

    01:44 And these teams that are demolition type of teams, and may be exposed to a airborne type of asbestos.

    01:53 Non-occupational.

    01:54 Exposure to soiled clothing.

    01:56 So now you are the spouse, let's say of your husband or wife, or whomever that's working in an industry that's exposed to now asbestos, and you are then washing the clothes.

    02:09 And these clothes have been soiled with asbestos that has come from let's say that your patient was working as a plumber, so on and so forth.

    02:17 Environmental exposure, geological sources.

    02:20 There are actual places where you can't help it.

    02:23 In the soil itself, there might be abundance of asbestos and so therefore, you live in a neighborhood as such, where, unfortunately, you get exposed to asbestos over a period of time.

    02:33 Resulting in what please? Our category big picture is restrictive lung disease Under restricted lung disease, we're walking through our first example of a pneumoconiosis type of restrictive issue.

    02:49 Exposure in terms of environment, non-environment.

    02:52 Next, well, what are we going to find? Well, here we do alveolar septum sputum sample And this you'll get from what's known as a BAL, which stands for Bronchoalveolar lavage.

    03:05 So you're pretty weighed on, your deep down in your lung and so therefore, you need to really get to sputum here to evaluate this properly.

    03:12 Well, for the most part, you'll be dealing with sputum quite a bit.

    03:16 as you know, especially when you're dealing with typical pneumonia and company.

    03:19 So here in the bronchoalveolar lavash what do you find? You find iron.

    03:25 Okay, take a look at the first two letters of ferruginous F-E there it is.

    03:29 That's your periodic table symbol for iron, isn't it? So ferruginous bodies is what you would find in your alveolar septum sputum via bronchoalveolar lavash.

    03:42 Now, what is it? These are reactive oxygen or nitrogen radicals which appear as then being golden brown fusiform rods resembling dumbbells.

    03:51 Okay now, there are two ways that you can then expose your particular ferruginous body.

    03:58 In other words, the appearance of it if you don't use Prussian blue, do you notice to what color your iron then appears if you use H&E? Good, it's a brown.

    04:09 Okay.

    04:10 So keep that in mind.

    04:11 If however with this type of history where your patient has been exposed to asbestos and you are examining the sputum, then high, you highly suspecting your patient suffering from asbestosis you then order a prussian blue stain is that clear? So be very careful, normally speaking.

    04:33 So, for this you can use this for hemochromatosis.

    04:36 You can use this here ferruginous bodies meaning to say both instances, you can expect there to be increased iron deposition, and well different tissues.

    04:47 Here were specifically in the sputum or the lung.

    04:50 So therefore, upon H and E stain this would then be appearing as golden brown fusiform.

    04:56 However, as I said, if you're suspecting your RN issue, then please order and look for a blue type of particle with prussian blue.

    05:06 Continue.

    05:06 What else are you going to find that it's extremely important pathologically, for asbestosis.

    05:11 It's the fact that the pleura, which is made up of your visceral pleura layer and here, the pleura ends up developing these plaques important.

    05:22 These are aptly pathognomonic for asbestosis Now, slow down here.

    05:27 Because you all should know, as far as asbestos exposure decades down the road sure, may result in various lung cancers.

    05:34 And these lung cancers under the umbrella of bronchogenic and mesothelioma.

    05:40 Why did I separate mesothelioma? because it is not a bronchogenic cancer.

    05:44 And bronchogenic cancer includes your small cell, non-small cell lung cancer, we'll talk about that in great detail when the time is right.

    05:51 But please note that mesothelioma is a separate lung cancer.

    05:55 Mesothelial cells are those cells histologically that then line the...

    06:01 what? Good.

    06:03 You're lining the serosa of many organs.

    06:06 So for example peritoneum, you think that has serosa? of course it does peritoneum.

    06:11 So therefore, does that have mesothelial cells? Yes, it does.

    06:15 And what about the lung? Of course the pleura has made mesothelial cells, Why am I bringing this up? Where are you finding the pathology here? upon gross examination, you can visually see this as being pleural plaques So the next question is, well, I have pleural plaques in your patient.

    06:35 Okay. I know my patient is asbestosis is the pleural plaque responsible for? Is this the triggering or the predisposing factor of going into mesothelioma? How convenient would that be? It's not.

    06:50 Okay so, you have pleural plaques that is pathognomonic for asbestosis, but please understand, this is not the predisposing factor you're going into mesothelioma, which is a pleural type of cancer.

    07:02 So keep it separate.

    07:04 This is benign, you know your patient has asbestos.

    07:07 What's up a cancer is your patient most likely going to go into? what kind of lung cancer? broncho, broncho, bronchogenic.

    07:15 Unfortunately, with advertisement and commercials, well, we have these people called lawyers, you've heard of such creatures.

    07:22 And so therefore, what do they say? Oh, you got exposed to asbestos because your loved one was working in the navy.

    07:31 And so therefore, if your loved one has now developed lung cancer, and most likely is mesothelioma seriously, a lawyer is not a doctor you are.

    07:42 So therefore, bronchogenic carcinoma fact is much more common of a cancer that is going to arise from asbestos and then is mesothelioma, be careful as to what the public sometimes gets educated, how they get educated.

    07:58 Is it the proper resource? Things that you want to keep in mind.

    About the Lecture

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

    Author of lecture Asbestosis: Introduction

     Carlo Raj, MD

    Carlo Raj, MD

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