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Disorders of the Pleura |

Curious Case of Preop Hypoxia: Asbestosis

Meenal Malviya, MD; Asad Omar, MD; Navneet Kumar, MD; Muhammad Ehtesham, MD
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Providence Hospital and Medical Center, Southfield, MI


Chest. 2014;145(3_MeetingAbstracts):259A. doi:10.1378/chest.1826519
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Abstract

SESSION TITLE: Pleural Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Patients coming for preoperative evaluation are often diagnosed for first time with underlying diseases that go unnoticed unless patients present for evaluation. One such example is hypoxia. We present 74 year-old male with no significant past medical history coming for preoperative evaluation for cataract surgery and was hypoxic. With careful assessment of history and physical exam along with imaging revealed asbestosis, thus highlighting importance of occupational exposure.

CASE PRESENTATION: A 74 year-old male with no significant past medical history came for medical clearance for cataract surgery. He was hypoxic (80% room air sitting). He was having dyspnea on exertion since last few months but never sought medical attention for it. He denied any cough, chest pain, orthopnea or paroxysmal dyspnea. Physical exam revealed fine end-inspiratory crackles bilaterally. CT Thorax of chest with contrast was negative for pulmonary embolism but showed pleural thickening, peribronchiolar thickening, fibrotic changes and pleural plaques. On further questioning he mentioned his occupation of plumber for 40 years which might have exposed him to asbestos. He never mentioned this to primary care physician and ignored to seek medical attention for his dyspnea. Currently, he is being followed at our pulmonary clinic for pulmonary function testing.

DISCUSSION: The diagnosis of Asbestosis, according to the current American Thoraxic Society 2004 guidelines, includes a) evidence of structural pathology either by histology or imaging b) evidence of environmental exposure c) exclusion of other likely causes. Our case fulfills the criteria for the diagnosis. The characteristics of the radiology that show asbestosis are defined as a fibrous change directly underneath the pleura such as subpleural dots, subpleural curvilinear lines, branching opacities, interlobular septum hyperplasia, etc. based on HRCT and there are few images showing typical honeycomb lung and tractional bronchiectasis. The presence of pleural plaque is a good indicator of asbestos exposure seen in most of the studies. Furthermore, pathological characteristics of asbestosis are centrilobular fibrosis developing at the periphery, and fibroblastic foci characteristic of chronic interstitial pneumonia are not often observed.

CONCLUSIONS: It is important for primary care physician in offering a low dose CT scan for people at risk for asbestos exposure to detect the asbestosis at earlier stage. Hypoxia and dyspnea on exertion are the initial clinical signs of all pneumoconiosis and occupational exposure should not be missed in our assessment.

Reference #1: Diagnosis and initial management of nonmalignant diseases related to asbestos.Am J Respir Crit Care Med. 2004.170:691-715.

DISCLOSURE: The following authors have nothing to disclose: Meenal Malviya, Asad Omar, Navneet Kumar, Muhammad Ehtesham

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