Asbestos: When the Dust Settles—An Imaging Review of Asbestos-related Disease1
Huw D. Roach, FRCR,
Gareth J. Davies, FRCR,
Richard Attanoos, MRCPath,
Michael Crane, FRCR,
Haydn Adams, FRCR and
Siân Phillips, FRCR
1 From the Department of Radiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom (H.D.R., G.J.D.); Departments of Histopathology (R.A.) and Radiology (M.C., H.A.), Llandough Hospital, Cardiff, United Kingdom; and Department of Radiology, Princess of Wales Hospital, Bridgend, United Kingdom (S.P.). Presented as an education exhibit at the 2001 RSNA scientific assembly. Received February 1, 2002; revision requested March 7 and received June 3; accepted June 19. Address correspondence to H.D.R. (e-mail: huwroach@doctors.org.uk).
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Figure 1. Posteroanterior radiograph of an asbestos-exposed patient shows a right-sided pleural effusion (arrows).
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Figure 2. Posteroanterior radiograph shows extensive calcified pleural plaques (arrows) that affect the chest wall, diaphragm, and pericardium. The costophrenic angles and apices are spared.
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Figure 3a. (a) Posteroanterior radiograph of an obese patient shows only a small amount of pericardial calcification (arrows). (b, c) Axial CT scans obtained with soft-tissue window settings show calcified anterior and paravertebral plaques (arrows) not seen on the radiograph.
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Figure 3b. (a) Posteroanterior radiograph of an obese patient shows only a small amount of pericardial calcification (arrows). (b, c) Axial CT scans obtained with soft-tissue window settings show calcified anterior and paravertebral plaques (arrows) not seen on the radiograph.
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Figure 3c. (a) Posteroanterior radiograph of an obese patient shows only a small amount of pericardial calcification (arrows). (b, c) Axial CT scans obtained with soft-tissue window settings show calcified anterior and paravertebral plaques (arrows) not seen on the radiograph.
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Figure 4. Axial high-resolution CT scan obtained with lung windows shows uncalcified anterior pleural plaque (arrows).
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Figure 5a. (a) Photograph (original magnification, approximately x0.5) shows multiple raised pearly plaques that arise from the parietal pleura. (b) Photomicrograph (original magnification, approximately x250; hematoxylin-eosin stain) shows paucicellular hyalinized pleural plaque with a basket-weave pattern and focal lymphocytic aggregate (arrow).
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Figure 5b. (a) Photograph (original magnification, approximately x0.5) shows multiple raised pearly plaques that arise from the parietal pleura. (b) Photomicrograph (original magnification, approximately x250; hematoxylin-eosin stain) shows paucicellular hyalinized pleural plaque with a basket-weave pattern and focal lymphocytic aggregate (arrow).
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Figure 6. Axial high-resolution CT scan shows an anterior pleural plaque with associated linear opacities that project into the underlying lung.
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Figure 7. Photograph (original magnification, approximately x0.5) of a whole lung section shows circumferential diffuse pleural thickening (arrows). The lung parenchyma shows honeycombing that indicates asbestosis (arrowheads).
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Figure 8a. (a) Axial CT scan of an asbestos-exposed person shows a left-sided pleural effusion (arrow). (b) Axial CT scan obtained 2 years later shows circumferential pleural thickening that extends into the major fissure (straight arrow) and contains flecks of calcification (curved arrow).
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Figure 8b. (a) Axial CT scan of an asbestos-exposed person shows a left-sided pleural effusion (arrow). (b) Axial CT scan obtained 2 years later shows circumferential pleural thickening that extends into the major fissure (straight arrow) and contains flecks of calcification (curved arrow).
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Figure 9a. (a) Posteroanterior radiograph shows pleural thickening with obliteration of the left costophrenic angle (arrows). There are also some associated linear parenchymal opacities (arrowheads). (b) Axial CT scan of the same patient shows circumferential pleural thickening (arrows).
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Figure 9b. (a) Posteroanterior radiograph shows pleural thickening with obliteration of the left costophrenic angle (arrows). There are also some associated linear parenchymal opacities (arrowheads). (b) Axial CT scan of the same patient shows circumferential pleural thickening (arrows).
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Figure 10a. (a) Posteroanterior radiograph shows an opacity in the right middle zone (arrows). (b) Axial CT scan of the same patient shows a peripheral mass that abuts thickened pleura, with comet tail distortion of the vascular structures (arrows).
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Figure 10b. (a) Posteroanterior radiograph shows an opacity in the right middle zone (arrows). (b) Axial CT scan of the same patient shows a peripheral mass that abuts thickened pleura, with comet tail distortion of the vascular structures (arrows).
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Figure 11. Axial CT scan shows an ovoid mass, pleural thickening, and linear comet tail of rounded atelectasis.
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Figure 12. Photomicrograph (original magnification, x400; hematoxylin-eosin stain) of a bronchoalveolar lavage specimen shows a classic asbestos body with a segmental dumbbell-shaped configuration (arrow).
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Figure 13. Photograph shows macroscopic appearance of "honeycomb" lung with subpleural accentuation typical of asbestosis (arrows). No pleural thickening is present on this section.
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Figure 14a. (a) Posteroanterior radiograph of a patient with asbestosis shows "shaggy" mediastinal and diaphragmatic contours. (b) Localized view of the lung bases of the same patient further illustrates the diffuse interstitial opacification.
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Figure 14b. (a) Posteroanterior radiograph of a patient with asbestosis shows "shaggy" mediastinal and diaphragmatic contours. (b) Localized view of the lung bases of the same patient further illustrates the diffuse interstitial opacification.
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Figure 15. Posteroanterior radiograph shows diffuse fine nodular and reticular opacification with irregularity of mediastinal and diaphragmatic contours. The costophrenic angles are blunted because of pleural thickening.
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Figure 16. Posteroanterior radiograph of an asbestos-exposed person shows parenchymal bands radiating in from the pleura in both mid zones (arrows). Diffuse pleural thickening is predominantly left-sided.
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Figure 17. Axial high-resolution CT scan shows a subpleural curvilinear opacity (arrows) thought to represent peribronchiolar fibrosis.
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Figure 18. High-resolution CT scan obtained with the patient in a prone position shows early subpleural curvilinear opacity (arrows). Prone as well as supine views have been recommended (20,26) to eliminate dependent opacities.
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Figure 19. High-resolution CT scan shows bilateral parenchymal bands (arrows).
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Figure 20. High-resolution CT scan shows subpleural areas of ground-glass attenuation (arrows).
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Figure 21. Prone high-resolution CT scan shows subpleural nodular and dotlike opacities (solid wide arrows) that coalesce to form subpleural curvilinear lines (open arrows). There are also interlobular (solid thin arrows) and intralobular (arrowheads) interstitial lines.
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Figure 22. High-resolution CT scan shows interlobular septal thickening (arrowheads).
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Figure 23. High-resolution CT scan depicts subpleural honeycombing (open arrows), interlobular septal thickening (solid arrows), and subpleural nodular opacities (arrowheads).
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Figure 24. High-resolution CT scan shows subpleural honeycombing.
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Figure 25a. (a) Photomicrograph (original magnification, x250; hematoxylin-eosin stain) of a malignant mesothelioma of the epithelioid subtype shows its tubulopapillary structure and numerous scattered psammomatous bodies (arrows). (b) Photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows a malignant mesothelioma of the sarcomatoid subtype: a cellular spindle cell tumor with a haphazard array of fascicles. There is marked cytonuclear pleomorphism and mitotic activity (arrows).
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Figure 25b. (a) Photomicrograph (original magnification, x250; hematoxylin-eosin stain) of a malignant mesothelioma of the epithelioid subtype shows its tubulopapillary structure and numerous scattered psammomatous bodies (arrows). (b) Photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows a malignant mesothelioma of the sarcomatoid subtype: a cellular spindle cell tumor with a haphazard array of fascicles. There is marked cytonuclear pleomorphism and mitotic activity (arrows).
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Figure 26. Posteroanterior radiograph shows left-sided lobulated thickening (arrowheads) and pleural effusion (arrow), findings characteristic of malignant mesothelioma.
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Figure 27. Photograph (original magnification, approximately x0.5) of a whole lung section from a patient with malignant mesothelioma shows diffuse encasement of lung tissue by firm pale tumor tissue, with extension along the fissure.
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Figure 28. Axial CT scan of a patient with a right-sided mesothelioma shows a benign pleural plaque (arrow) engulfed by tumor tissue.
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Figure 29. Axial CT scan shows a right-sided mesothelioma with extension along the major fissure (arrow) and chest wall invasion (arrowhead).
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Figure 30. Axial CT scan of a patient with a left-sided malignant mesothelioma shows contraction of the hemithorax and chest wall invasion (arrow).
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Figure 31. Axial CT scan of a patient with a right-sided mesothelioma shows invasion and encasement of the pericardium (arrowheads).
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Figure 32. Axial CT scan of the upper abdomen shows transdiaphragmatic extension and hepatic invasion by a malignant pleural mesothelioma.
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Figure 33. Axial CT scan shows a left-sided mesothelioma with mediastinal encasement and lymphadenopathy (arrowheads).
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Figure 34. Axial CT scan of a patient with a right-sided mesothelioma shows a nodule in the left lung (arrow) thought to represent a metastasis. The patient did not have this finding confirmed surgically, however, owing to comorbid disease.
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Figure 35. Photograph of a macroscopic section of an exophytic pale carcinoma in the lower lobe bronchus shows distal mucoid impaction.
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Figure 36. Axial CT scan shows a large left lower lobe carcinoma in a patient with asbestos-related plaques (arrows).
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Copyright © 2002 by the Radiological Society of North America.
