Sunday, November 22, 2015

Asbestos,Mesothelioma,Aspergilloma and the lung cancer from Passmedicine (MRCP)


Asbestos can cause a variety of lung disease from benign pleural plaques to mesothelioma.

Pleural plaques

Pleural plaques are benign and do not undergo malignant change. They are the most common form of asbestos related lung disease and generally occur after a latent period of 20-40 years.

 Pleural thickening

Asbestos exposure may cause diffuse pleural thickening in a similar pattern to that seen following an empyema or haemothorax. The underlying pathophysiology is not fully understood.


The severity of asbestosis is related to the length of exposure. This is in contrast to mesothelioma where even very limited exposure can cause disease. The latent period is typically 15-30 years. Asbestosis typically causes lower lobe fibrosis. As with other forms of lung fibrosis the most common symptoms are shortness-of-breath and reduced exercise tolerance.


Mesothelioma is a malignant disease of the pleura. Crocidolite (blue) asbestos is the most dangerous form. 

Possible features

  • progressive shortness-of-breath
  • chest pain
  • pleural effusion

Patients are usually offered palliative chemotherapy and there is also a limited role for surgery and radiotherapy. Unfortunately the prognosis is very poor, with a median survival from diagnosis of 8-14 months.

Lung cancer

Asbestos exposure is a risk factor for lung cancer and also has a synergistic effect with cigarette smoke.


An aspergilloma is a fungus ball which often colonises an existing lung cavity (e.g. secondary to TB, lung cancer or cystic fibrosis)

Usually asymptomatic but features may include

  • cough
  • haemoptysis (may be severe)


  • CXR containing a rounded opacity
  • high titres Aspergillus precipitins

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