Limits...
Grand rounds: asbestos-related pericarditis in a boiler operator.

Abejie BA, Chung EH, Nesto RW, Kales SN - Environ. Health Perspect. (2008)

Bottom Line: Pulmonary function testing showed mild obstruction and borderline low diffusing capacity.Based on the patient's occupational history, the presence of pleural pathology consistent with asbestos, previous evidence that asbestos can affect the pericardium, and absence of other likely explanations, we concluded that his pericarditis was asbestos-related.Similar to pleural thickening and plaque formation, asbestos may cause progressive fibrosis of the pericardium.

View Article: PubMed Central - PubMed

Affiliation: Department of Environmental Health (Environmental & Occupational Medicine and Epidemiology), Harvard School of Public Health, Boston, Massachusetts, USA.

ABSTRACT

Context: Occupational and environmental exposures to asbestos remain a public health problem even in developed countries. Because of the long latency in asbestos-related pathology, past asbestos exposure continues to contribute to incident disease. Asbestos most commonly produces pulmonary pathology, with asbestos-related pleural disease as the most common manifestation. Although the pleurae and pericardium share certain histologic characteristics, asbestos-related pericarditis is rarely reported.

Case presentation: We present a 59-year-old man who worked around boilers for almost 30 years and was eventually determined to have calcific, constrictive pericarditis. He initially presented with an infectious exacerbation of chronic bronchitis. Chest radiographs demonstrated pleural and pericardial calcifications. Further evaluation with cardiac catheterization showed a hemodynamic picture consistent with constrictive pericarditis. A high-resolution computerized tomography scan of the chest demonstrated dense calcification in the pericardium, right pleural thickening and nodularity, right pleural plaque without calcification, and density in the right middle lobe. Pulmonary function testing showed mild obstruction and borderline low diffusing capacity.

Discussion: Based on the patient's occupational history, the presence of pleural pathology consistent with asbestos, previous evidence that asbestos can affect the pericardium, and absence of other likely explanations, we concluded that his pericarditis was asbestos-related.

Relevance to clinical practice: Similar to pleural thickening and plaque formation, asbestos may cause progressive fibrosis of the pericardium.

Show MeSH

Related in: MedlinePlus

Hemodynamic tracing from cardiac catheterization. Simultaneous pressure measurements in the right (R) and left (L) ventricles demonstrate approximate equalization of diastolic filling pressures. End diastole is indicated by the arrow.
© Copyright Policy - public-domain
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2199309&req=5

f1-ehp0116-000086: Hemodynamic tracing from cardiac catheterization. Simultaneous pressure measurements in the right (R) and left (L) ventricles demonstrate approximate equalization of diastolic filling pressures. End diastole is indicated by the arrow.

Mentions: Despite his pulmonary treatment, the patient continued to have fatigue, dyspnea, and occasional presyncopal events. As a result, he was referred to a cardiologist in May 2005. Physical examination was remarkable for obesity and distant heart sounds. Increased jugular venous pressure, Kussmaul’s sign, cyanosis, and peripheral edema were not present. His electrocardiogram showed sinus rhythm with occasional premature atrial beats. Review of chest radiographs revealed calcifications in the pleura and noncircumferential calcification of the pericardium. Echocardiogram showed mildly depressed left ventricular function and intermittent interventricular septal displacement in diastole, but no other findings diagnostic of pericardial constriction were noted. Based on a presumptive diagnosis of pericardial constriction, the patient underwent cardiac catheterization. Hemodynamic findings included intermittent equalization of right and left ventricular end diastolic filling pressures consistent with constrictive pericarditis (Figure 1). Partial calcification of the pericardium was seen under fluoroscopy. No obstructive coronary artery disease was present. The patient was treated with diuretics. He has remained stable, although with a limited capacity for any exertion.


Grand rounds: asbestos-related pericarditis in a boiler operator.

Abejie BA, Chung EH, Nesto RW, Kales SN - Environ. Health Perspect. (2008)

Hemodynamic tracing from cardiac catheterization. Simultaneous pressure measurements in the right (R) and left (L) ventricles demonstrate approximate equalization of diastolic filling pressures. End diastole is indicated by the arrow.
© Copyright Policy - public-domain
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2199309&req=5

f1-ehp0116-000086: Hemodynamic tracing from cardiac catheterization. Simultaneous pressure measurements in the right (R) and left (L) ventricles demonstrate approximate equalization of diastolic filling pressures. End diastole is indicated by the arrow.
Mentions: Despite his pulmonary treatment, the patient continued to have fatigue, dyspnea, and occasional presyncopal events. As a result, he was referred to a cardiologist in May 2005. Physical examination was remarkable for obesity and distant heart sounds. Increased jugular venous pressure, Kussmaul’s sign, cyanosis, and peripheral edema were not present. His electrocardiogram showed sinus rhythm with occasional premature atrial beats. Review of chest radiographs revealed calcifications in the pleura and noncircumferential calcification of the pericardium. Echocardiogram showed mildly depressed left ventricular function and intermittent interventricular septal displacement in diastole, but no other findings diagnostic of pericardial constriction were noted. Based on a presumptive diagnosis of pericardial constriction, the patient underwent cardiac catheterization. Hemodynamic findings included intermittent equalization of right and left ventricular end diastolic filling pressures consistent with constrictive pericarditis (Figure 1). Partial calcification of the pericardium was seen under fluoroscopy. No obstructive coronary artery disease was present. The patient was treated with diuretics. He has remained stable, although with a limited capacity for any exertion.

Bottom Line: Pulmonary function testing showed mild obstruction and borderline low diffusing capacity.Based on the patient's occupational history, the presence of pleural pathology consistent with asbestos, previous evidence that asbestos can affect the pericardium, and absence of other likely explanations, we concluded that his pericarditis was asbestos-related.Similar to pleural thickening and plaque formation, asbestos may cause progressive fibrosis of the pericardium.

View Article: PubMed Central - PubMed

Affiliation: Department of Environmental Health (Environmental & Occupational Medicine and Epidemiology), Harvard School of Public Health, Boston, Massachusetts, USA.

ABSTRACT

Context: Occupational and environmental exposures to asbestos remain a public health problem even in developed countries. Because of the long latency in asbestos-related pathology, past asbestos exposure continues to contribute to incident disease. Asbestos most commonly produces pulmonary pathology, with asbestos-related pleural disease as the most common manifestation. Although the pleurae and pericardium share certain histologic characteristics, asbestos-related pericarditis is rarely reported.

Case presentation: We present a 59-year-old man who worked around boilers for almost 30 years and was eventually determined to have calcific, constrictive pericarditis. He initially presented with an infectious exacerbation of chronic bronchitis. Chest radiographs demonstrated pleural and pericardial calcifications. Further evaluation with cardiac catheterization showed a hemodynamic picture consistent with constrictive pericarditis. A high-resolution computerized tomography scan of the chest demonstrated dense calcification in the pericardium, right pleural thickening and nodularity, right pleural plaque without calcification, and density in the right middle lobe. Pulmonary function testing showed mild obstruction and borderline low diffusing capacity.

Discussion: Based on the patient's occupational history, the presence of pleural pathology consistent with asbestos, previous evidence that asbestos can affect the pericardium, and absence of other likely explanations, we concluded that his pericarditis was asbestos-related.

Relevance to clinical practice: Similar to pleural thickening and plaque formation, asbestos may cause progressive fibrosis of the pericardium.

Show MeSH
Related in: MedlinePlus