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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.

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Related in: MedlinePlus

High-resolution computerized tomography scan image with patient in prone position demonstrating calcification of anterior pericardium.
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f2-ehp0116-000086: High-resolution computerized tomography scan image with patient in prone position demonstrating calcification of anterior pericardium.

Mentions: Further pulmonary evaluation included a high-resolution computerized tomography scan of the chest demonstrating dense calcification of the anterior pericardium (Figure 2); right pleural thickening and nodularity; right pleural plaque without calcification; right middle-lobe linear density consistent with scarring or atelectasis; and bilateral nodules, all > 5 mm in diameter. Pulmonary function testing in December 2006 demonstrated several abnormalities (Table 1). Total lung capacity (TLC) was normal, in spite of a markedly elevated residual volume (RV). The forced expiratory volume in 1 sec (FEV1) and FEV1/FVC (forced expiratory vital capacity) supported mild obstruction, and the increased RV and the RV/TLC ratio documented significant air trapping. The patient’s diffusing capacity was borderline and considered mildly decreased for that laboratory. There were moderate increases in the FVC, FEV1, and forced expiratory flow 25–75% after the administration of a bronchodilator, which suggested some reversibility, although these increases were not considered significant by standard criteria [American Thoracic Society (ATS) 1995; Celli and MacNee 2004]. A comparison with previous workplace spirometry between 1990 and 2004 did not show accelerated lung function loss but did demonstrate similar patterns with a previous FEV1 as low as 66% predicted.


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

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

High-resolution computerized tomography scan image with patient in prone position demonstrating calcification of anterior pericardium.
© Copyright Policy - public-domain
Related In: Results  -  Collection

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

f2-ehp0116-000086: High-resolution computerized tomography scan image with patient in prone position demonstrating calcification of anterior pericardium.
Mentions: Further pulmonary evaluation included a high-resolution computerized tomography scan of the chest demonstrating dense calcification of the anterior pericardium (Figure 2); right pleural thickening and nodularity; right pleural plaque without calcification; right middle-lobe linear density consistent with scarring or atelectasis; and bilateral nodules, all > 5 mm in diameter. Pulmonary function testing in December 2006 demonstrated several abnormalities (Table 1). Total lung capacity (TLC) was normal, in spite of a markedly elevated residual volume (RV). The forced expiratory volume in 1 sec (FEV1) and FEV1/FVC (forced expiratory vital capacity) supported mild obstruction, and the increased RV and the RV/TLC ratio documented significant air trapping. The patient’s diffusing capacity was borderline and considered mildly decreased for that laboratory. There were moderate increases in the FVC, FEV1, and forced expiratory flow 25–75% after the administration of a bronchodilator, which suggested some reversibility, although these increases were not considered significant by standard criteria [American Thoracic Society (ATS) 1995; Celli and MacNee 2004]. A comparison with previous workplace spirometry between 1990 and 2004 did not show accelerated lung function loss but did demonstrate similar patterns with a previous FEV1 as low as 66% predicted.

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