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Radiographs of patients from a metropolitan Veteran's Affairs hospital, located in the proximity of a high concentration of manufacturing, were examined for pleural plaques. Patients with positive pleural findings were further investigated to assess the frequency at which radiographs and work history were deemed suspicious for dust exposure to asbestos. Consecutive posteroanterior and lateral radiographs of 1,212 patients (96% male) were evaluated by a NIOSH certified B-reader. Pleural abnormalities reflecting asbestos exposure were found in 28 (2.3%) of the radiographs. All 28 patients were males, ages 50 to 98 years old. Twenty radiographs showed bilateral abnormalities and 20 were calcified. One film showed en face involvement, and three had plaques appreciated only in profile. Obliteration of the costophrenic sulcus was seen in three patients. A review of previous radiographs found no significant progression in the degree of pleural disease. Four had associated interstitial changes suggestive of asbestosis, and none had parenchymal masses. In several cases, pleural plaques with characteristics of asbestos related damage were misinterpreted by radiologists. Fourteen patients had an occupational history of asbestos exposure, but the possibility of dust inhalation was mentioned in only four. The authors conclude that although a significant percentage of patients exhibited radiographic evidence of asbestos exposure, patient asbestos exposure histories were ignored by physicians. The authors state that there is a need for a high degree of suspicion of asbestos related lung diseases in order to allow for early treatment.
American Journal of Industrial Medicine, 30(6):726-729, 1996. (17 references)
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