Asbestos pleuritis J92.0

Asbestos pleurisy is the occurrence of small benign (Görlitz 2010) pleural effusions after exposure to asbestos (Herold 2022). It usually occurs unilaterally in the early stage, later also bilaterally (Hien 2012).

Asbestos pleurisy is the most common pleuro-pulmonary complication following exposure to asbestos (Herold 2022). It occurs in about 20% of those exposed (Hien 2012).

Caused by exposure to asbestos (Herold 2022).

After inhalation of dusts containing asbestos fibers, they are deposited in the pleural area and trigger an inflammatory mesothelial reaction (Kroegel 2013).

Asbestos pleurisy manifests in the first 20 years after exposure (Herold 2022).

Initially, it usually occurs unilaterally, but can be detectable bilaterally as the disease progresses (Hien 2012).

Recurrent small pleural effusions are found, often without further symptoms (Herold 2022).

However, there may also be:

- fever

- Feeling of illness (Hien 2012)

Diagnosis is made by cytologic and biochemical examination of pleural effusions and pleural biopsies, respectively (Kishimoto 2014).

Chest X-ray

The diagnosis of asbestos pleurisy is usually made radiologically (Kraus 2020).

Sonography

Sonographic evidence of unilateral or bilateral effusions can be obtained.

• BSG increase (Hien 2012)

In the majority of cases, the exudate is serous or bloody (Kasper 2015) and tinged with granulocytes (or bloody) (Hien 2012).

It may be present and complicate differentiation from mesothelioma:

• clustered mitoses
• Irritant forms
• cell atypia
• proliferating mesothelial cells in connective tissue
• Eosinophilia (more indicative of asbestos pleurisy).

(Hien 2012)

Electron microscopically, asbestos fibers may be detectable. Only rarely are asbestos bodies found by light microscopy (Hien 2012).

• Mesothelioma

Differentiation from mesothelioma is often difficult (Hien 2012). Mesothelioma can only be excluded after 3 years of follow-up (Konietzko 2006).

• Tuberculosis
• Infections with pleural involvement
• Tumor disease (Kraus 2020)

• Fibrosis

It is not uncommon for asbestos pleurisy to cause pleural fibrosis (Hien 2012).

• Verschwartung

After spontaneous regression, asbestos pleuritis leaves a Verschwartung of the diaphragm-rib angle (Hien 2012). Typical is the Verschwartung of the pleura in the sense of a Hyalinosis complicata (Raithel 1996).

• Round atelectasis

These are usually symmetrical and are found predominantly in the dorsobasal lower lobes after asbestos pleuritis. They are typical of benign asbestos injury but are not specific (Kraus 2020).

• Pericarditis

If pericarditis is also present, there is a risk of pericardial ta

Since the disease usually heals spontaneously within 6 months, no therapy is required in most cases (Kroegel 2013).

Medications that can be used for symptomatic treatment include anti-inflammatories such as diclofenac (Hien 2012)

In persistent effusions, pleurodesis may be required (Hien 2012).

The effusion may regress spontaneously or slowly (Kasper 2015). It is not uncommon for progression to be followed by severe defect healing with diffuse pleural fibrosis and severe restriction, sometimes even respiratory insufficiency (Konietzko 2006).

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