All clinicians should have a low threshold for ordering a chest x-rays if there is a history of asbestos exposure. Refer for CT scan even if the chest x-ray is normal if there is a strong suspicion of an underlying respiratory problem.
Pleural plaques
These are benign collagenous deposits that develop on the parietal pleura. They are most often highlighted on a chest X-ray report and seldom require further investigation.
Pleural plaques do not usually cause impairment of lung function or any respiratory disability and are not pre-malignant.
However, they are important as they corroborate prior asbestos exposure whether suspected or not. It is important to be clear about the difference between pleural plaques and other asbestos-related conditions when discussing the problems with colleagues or patients.
If you feel comfortable with the facts, advise patients with pleural plaques of
- Risks of other asbestos-related lung disease
- The importance of warning symptoms such progressive breathlessness, chest pain, and haemoptysis which require urgent assessment
- When appropriate, smoking cessation is of paramount importance owing to increased risks of lung cancer.
Refer patients with pleural plaques who report:
- Shortness of breath
- Chest pain
- Persistent cough
- Haemoptysis .
Up-to-date medico-legal advice can be provided by charities such as www.clydesideactiononasbestos.org.uk/
Diffuse pleural thickening
Diffuse pleural thickening refers to thickening of the visceral pleural and may be suggested if the chest x-ray is reported as showing blunting of costophrenic angle.
Diffuse pleural thickening is a different condition from pleural plaques (which affect the parietal pleura) and may cause shortness of breath and/or chest pain.
Referral for detailed imaging (CT) and lung function are often helpful.
Refer cases of suspected diffuse pleural thickening to Dr Reid at the WGH.
Asbestosis
Asbestosis is a fibrosing lung disease which presents in a similar manner to other fibrosing lung conditions eg progressive breathlessness and cough. Its presence may be suggested by clinical features (crackles on auscultation) or reported on the chest X-ray as an interstitial lung disease.
Cases of suspected asbestosis may be referred to the Interstitial Lung Disease clinic at the RIE or to Dr Reid at the Western General Hospital.
Mesothelioma
Mesothelioma is an aggressive malignancy arising from mesothelial cells. Common sites include the pleura or peritoneum. Pleural mesothelioma usually presents with breathlessness and/or persistent chest wall pain. Other symptoms may include night sweats.
If mesothelioma is suspected an urgent cancer referral should be made to any the lung cancer service or the on-call respiratory SpR should be contacted and admission arranged to facilitate further investigation.
