Early Asbestosis in a Retired Pipe Fitter

Author: V. Dimov, M.D., The Cleveland Clinic
Last updated: March 2006

78 yo CM complains of SOB after 3-4 flights of stairs.

PMH:
HTN, BPH, PUD, High cholesterol, Arthritis, Colon cancer s/p colectomy 16 years ago

Medications:
Verapamil, Prevacid, Zocor, Avapro, Doxazosim

Social history:
Former smoker, stopped 30 years ago, 30 pack years. He is a retired pipe fitter and had asbestos exposure, retired 14 years ago.

Physical examination:
Vital signs 150/68 88 14 SpO2 98% on RA

WD/WN in NAD
Chest: faint inspiratory crackles on the right base
CVS: RSS, clear S1S2
Abd: soft, NT, ND, +BS
Ext: no clubbing

What do you think is going on?
COPD?
Asbestosis?

What would you do?
CXR, request any old CXRs for comparison
CT chest
PFTs
Pulmonary consult

CBC, BMP

CXR in early asbestosis shows plaques above the left and right hemidiaphragms and early basilar fibrosis.


Normal PFTs in early asbestosis

What happened?
CXRs from the last 5 years were reviewed and showed plaques above the left and right hemidiaphragms. Tenting of the right diaphragm was first noted 4 years ago. There was evidence of early basilar fibrosis.

CT scan of the chest showed (B) pleural plaques noted, more on the left and early peripheral fibrosis.

PFT are normal.

What happened next?
The patient has early asbestosis without significant functional impairment. A 6-month follow-up with pulmonology was arranged for PFT, DLCO and HRCT.

Final diagnosis:
Asbestosis-related lung disease

References:
Asbestosis. eMedicine.