Placas pleurales por inhalación de fibras de asbesto: reporte de dos casos y revisión de literatura / Pleural plaques by inhalation of asbestos fibers: report of two cases and literature review

INTRODUCCIÓN: Las placas pleurales por fibras de asbesto se caracterizan por lesiones compuestas por tejido fibroso que se ubican en la pleura parietal. Suelen aparecer hasta en un 3% a 58% de los trabajadores que estuvieron expuestos a fibras de asbesto, y en un 0,5% a 8% en población general. El OBJETIVO de este artículo es presentar dos casos clínicos de pacientes a los que se les detectó en la radiografía de tórax alteraciones pleurales posiblemente asociadas a la exposición a fibras de asbesto. CASOS CLÍNICOS: Caso 1. Paciente de sexo masculino de 49 años, trabajador de la construcción con antecedentes de exposición a fibras de asbesto. Se le realizó una radiografía de tórax con técnica OIT (Organización Internacional del Trabajo), la que evidenció alteraciones pleurales focales. Una tomografía axial computarizada de tórax, confirmó la presencia de placas pleurales. Caso 2. Paciente de sexo femenino de 79 años, jefa de hogar, sin exposición laboral conocida a fibras de asbesto. En una radiografía de tórax anteroposterior, se observó la presencia de una placa pleural focal. Se solicitó una tomografía axial computarizada de tórax, la que confirmó la presencia de placas pleurales. CONCLUSIÓN: La radiografía de tórax con técnica OIT es el instrumento básico para la identificación de enfermedades relacionadas con la exposición a fibra de asbesto. El estudio debe ser completado con una tomografía axial computarizada de tórax cuya sensibilidad es mayor permitiendo detectar tempranamente las anomalías pleurales. Es fundamental la historia ocupacional detallada ya que constituye el método más fiable y práctico para medir la exposición a fibra de asbesto.

INTRODUCTION: Asbestos fiber pleural plaque is characterized by lesions composed of fibrous tissue that are located in the parietal pleura. They usually appear in up to 3 to 58% of workers who were exposed to asbestos fiber, and 0.5 to 8% in the general population. The OBJECTIVE of this article is to present two clinical cases of patients who were detected in the chest radiograph pleural alterations associated with exposure to asbestos fibers. CLINICAL CASES: First case: 49-year-old male patient, building worker with a history of exposure to asbestos fibers. Focal pleural alterations were detected by a chest x-ray performed according ILO (International Labour Organization) technique. The presence of pleural plaques was confirmed in a computed tomography of the chest. Second case: Holder, without occupational exposure to asbestos fibers. An anteroposterior chest radiography showed the presence of focal pleural plaque in a CT scan of the chest. CONCLUSION: Chest x-ray with ILO technique is the basic instrument for the identification of diseases related to asbestos fiber exposure. The study should be completed with a CT scan of the chest whose sensitivity is greater, allowing early detection of pleural abnormalities. Detailed occupational history is essential, as it is the most reliable and practical method to measure asbestos fiber exposure.

Hallazgos imagenológicos en la enfermedad pleuropulmonar asociada al asbesto / Imaging findings in pleuropulmonary disease associated with asbestos

Abestos-related pleuropulmonary disease involves a number of pathologic conditions that share inhalation exposure to asbestos fibers as a common factor. Dose and time of exposure have a role in the clinical manifestations of it, the main ones being benign pleural disease, asbestosis, malignant mesothelioma and bronchogenic carcinoma. Despite the ban on asbestos material usage in Chile, there is a long latency between exposure and clinical manifestations, which lead to it being still a relevant public health issue to this day. We present a series of representative images of abestos-related pleuropulmonary disease diagnosed at our centre. The pathogeny and radiologic manifestations are discussed, with an emphasis on the latter.

Sonography of the lungs and pleura

The role of Transthoracic Sonography in the evaluation of chest diseases has already been accepted throughout the world. Though Ultrasound [US] is not widely established as a routine method, but the advantages of low-cost, bedside availability and lack of ionizing radiation exposure has made it an indispensable diagnostic tool in the modern pulmonary medicine. US supplements the conventional chest X-ray and computed tomography and closes the gap between them. Besides, it is invaluable in the interventional procedures of chest and pleural space and it is suited to critically ill patients in need of bedside investigations. This article reviews the sono-graphic morphology of the pleural and peripheral pulmonary diseases

Pleuro-biliary fistula--a delayed complication following open cholecystectomy.

A 24-year-old lady presented with bilious expectoration and history suggestive of obstructive jaundice, 16 months following open cholecystectomy. Pleurocentesis was done, followed by intercostal drainage, which drained about 300 mL bilious fluid per day for a month. Her symptoms of obstructive jaundice were relieved. A pleuro-biliary fistula was demonstrated by percutaneous transhepatic cholangiogram, HIDA scan and ERCP, which showed complete cut-off at the lower end. The patient underwent bilio-enteric bypass with gastric access loop, with complete healing of the pleuro-biliary fistula.