First AD

Second AD

A 56-year-old construction worker presents with dry cough.

Ill-defined curvilinear opacities are seen projecting over both lung fields predominantly in the mid and lower zone with sparing of the apices.

Answer: 2. Asbestos-related pleural plaques. 

Chronic exposure to asbestos (in the form of inhalation of fibers) can cause a number of neoplastic and non-neoplastic manifestations in the chest and pleural cavity 

. The constellation of these manifestations is termed as asbestos-related diseases.

Occupational exposure to asbestosis is seen in

Manufacture and repair of gaskets and brake linings.

Manifestations of long-term asbestos exposure include:					

. These can be hemorrhagic and tend to recur 

: Areas of pleural fibrosis commonly involving the parietal pleura, especially the posterolateral and lateral chest wall with sparing of the costophrenic angles

. Calcification is seen only 10-15% percent of the cases but bilateral calcified pleural plaques are very specific for asbestos exposure 

: This is a non-specific finding and is a result of fusion of the visceral and parietal pleura following multiple benign pleural effusions 

. Unlike plaques, thickening involves both parietal and visceral pleura 

Secondary to inflammatory, fibrosis and subsequent in folding of the pleural fold into the lung as it matures and contracts

It is seen as a rounded pleural based peripheral opacity with a typical comet tail/crow feet appearance of the adjacent Broncho vascular structures going into the mass

Pulmonary fibrosis secondary to long-term asbestos exposure (usually more than 20 years)

Imaging features are non-specific and include areas of ground-glass opacification with small nodular opacities and ill-defined diaphragmatic contours. HRCT shows subpleural fibrotic strands in early phase along with the above features

Commonly affects the pleura, however can also affect the peritoneum and pericardium.

This has a long latency period of more than 30 years and a poor prognosis

Imaging features include generalized lobulated thickening of the pleura with decreased volume of the hemithorax. It often extends along the fissures and invades into adjacent mediastinal structures 

Norbet C, Joseph A, Rossi SS, Bhalla S, Gutierrez FR. Asbestos-Related Lung Disease: A Pictorial Review. Curr Probl Diagn Radiol. 2015;44:371–82. [PubMed]

Roach HD, Davies GJ, Attanoos R, Crane M, Adams H, Phillips S. Asbestos: when the dust settles-an imaging review of asbestosârelated disease. Radiographics 2002; 22: S167–84.

Image IQ

A construction worker presents with a dry cough, can you diagnose this patient?

Image IQ: 56-year-old construction worker presents with dry cough