Review of Respiratory Medicine - Volumen 24, Número 1 - March 2024

Case Reports

Pleural Plaques Caused by Possible Non-Occupational Asbestosis

Placas pleurales por probable asbestosis no ocupacional

ABSTRACT

In the context of an isolated bronchial hyperreactivity condition, the patient presents bilateral pleural images consistent with chronic asbestos exposure

Key words:

Bronchial Hyperreactivity, Asbestos, Pleura

RESUMEN

Paciente masculino, sin antecedentes conocidos, nunca tabaquista, que en el contexto de un cuadro de hiperreactividad bronquial aislado, se evidencian imágenes pleurales bilaterales compatibles con exposición crónica a asbesto.

Palabra clave: Hiperreactividad bronquial, Asbestos, Pleura

Received: 01/11/2023

Accepted: 11/08/2023

We present the case of a frequent user of the Metro B line in the City of Buenos Aires. Due to a respiratory condition as an isolated finding, calcified pleural images compatible with pleural asbestosis were detected.

Male patient, 68 years old. No clinical history. Non-smoker. Retired teacher.

When exposed to wood dust in a confined en­vironment, the patient experienced an episode of bronchial hyperreactivity that resolved with inhaled budesonide/formoterol, and symptoms did not recur subsequently.

A simple chest X-ray was performed, revealing two heterogeneous radiopacities for the right car­diac silhouette and one opacity for the left cardiac silhouette (Figure 1).

Subsequently, a chest computed tomography (CT) was performed, revealing bilateral calcified pleural plaques (Figure 2) and a solid nodule in the lower left lobe of approximately 15 mm (Figure 3).

The problem oriented medical record didn’t report any recent travel, contact with animals, or exposure to inhaled toxic substances in the context of the patient’s working environment. But the in­dividual did confirm that between 2005 and 2019 he commuted daily in Line B of the Buenos Aires underground system, traveling from the first to the last station.

DISCUSSION

There is extensive knowledge that exposure to asbestos can lead to pulmonary conditions. Such exposure can be either occupational or non-occupational, and within the latter, it is further described as environmental, for cases where the patient resides near establishments where hygiene and industrial safety conditions are not adequately implemented, and domestic or household, espe­cially when industrial substances are brought home by the worker, for example, through their work clothing.¹

Another described para-occupational exposure is through exposure to commercial products containing asbestos that are used globally or are already established. These products are diverse and include automobile brakes, asbestos cement products, textiles, adhesives, insulation, duct parts, and materials for roofing and flooring.²

Health conditions caused by this mineral in humans are also classified into two groups: non-neoplastic, such as pleural plaques, “round atel­ectasis,” or asbestos-related pulmonary fibrosis, and neoplastic, among which pleural mesothelioma (MTM) and bronchopulmonary cancer stand out.³

Non-occupational asbestosis could account for nearly 20% of MTMs in industrialized countries.⁴ Although the relationship between asbestos and pulmonary fibrosis has been known since the last century, the production of this mineral on an in­ternational level continued until the 1940s. It was only in the 1980s that its carcinogenic properties became clearly recognized, through Wagner’s ini­tial article that associated asbestos with malignant pleural mesothelioma (MPM). From that moment, efforts were made to reduce asbestos production and promote its replacement with other materials.

In our country, starting from Resolution No. 823/2001 of the Ministry of Health, the produc­tion, importation, commercialization, and use of asbestos fibers, specifically the chrysotile variety, and products containing them, are prohibited as from January 1, 2003.⁵

Between 2011 and 2013, 8 years after the afore­mentioned resolution, the Government of the City of Buenos Aires acquired old metro wagons that belonged to the metro of Madrid and Japan, manu­factured during the 70s and 80s, respectively, to be used for the city’s underground system.

In 2017, workers from the Metro de Madrid informed their counterparts in Buenos Aires that the trains they had acquired were contaminated with asbestos. This situation came to light when Spanish workers were found to be ill due to asbes­tos exposure; even one of them had died. Up to that point, 84 workers were identified as affected by exposure to asbestos, 6 of which developed cancer, and 3 passed away.⁶

In the case we are presenting, there are no precedents of occupational exposure, no residence near factories with potential use of asbestos, and no family members with high-risk occupations. It appears to be a case of non-occupational as­bestosis, in which the only record of contact with this mineral is the daily commute in a means of transportation where asbestos contamination has been confirmed.⁷

Acknowledgment

To Pleural Plaques and Asbestosis

REFERENCES

1. Rey D. Asbestosis no ocupacional: un riesgo potencial a tener en consideración. Rev Am Med Resp. 2022;2:186-94.

2. Noonan C. Environmental asbestos exposure and risk of mesothelioma. Ann Transl Med 2017; 5:234.

3. Rey D. Asbestosis: un problema del siglo XX que persiste en el siglo XXI. Rev Am Med Resp. 2019;4:253-254

4. Goldberg M, Lucea D. The health impact of non occupational exposure to asbestos: what do we know? Eur J Cancer Prev. 2009; 18:489-503. https://doi.org/10.1097/CEJ.0b013e32832f9bee

5. Ministerio de Salud de la Nación. Resolución 823/2001. Prohíbase la producción, importación, comercialización y uso de fibras de asbesto variedad crisotilo y productos que las contengan, a partir del 1.° de enero de 2003.

6. https://www.tiempoar.com.ar/informacion-general/asbesto-drama-subterraneo/

7. https://asbestoenelsubte.com.ar/asbesto-encontramos.html