Asbestos-related pleural and lung fibrosis in patients with retroperitoneal fibrosis.
BACKGROUND
Retroperitoneal fibrosis (RPF) is a rare fibroinflammatory disease that leads to hydronephrosis and renal failure. In a case-control study, we have recently shown that asbestos exposure was the most important risk factor for RPF in the Finnish population. The aim of this study was to evaluate the relation of asbestos exposure to radiologically confirmed lung and pleural fibrosis among patients with RPF.


METHODS
Chest high-resolution computed tomography (HRCT) was performed on 16 unexposed and 22 asbestos-exposed RPF patients and 18 asbestos-exposed controls. Parietal pleural plaques (PPP), diffuse pleural thickening (DPT) and parenchymal fibrosis were scored separately.


RESULTS
Most of the asbestos-exposed RPF patients and half of the asbestos-exposed controls had bilateral PPP, but only a few had lung fibrosis. Minor bilateral plaques were detected in two of the unexposed RPF patients, and none had lung fibrosis. DPT was most frequent and thickest in the asbestos-exposed RPF-patients. In three asbestos-exposed patients with RPF we observed exceptionally large pleural masses that were located anteriorly in the pleural space and continued into the anterior mediastinum.Asbestos exposure was associated with DPT in comparisons between RPF patients and controls (case-control analysis) as well as among RPF patients (case-case analysis).


CONCLUSIONS
The most distinctive feature of the asbestos-exposed RPF patients was a thick DPT. An asbestos-related pleural finding was common in the asbestos-exposed RPF patients, but only a few of these patients had parenchymal lung fibrosis. RPF without asbestos exposure was not associated with pleural or lung fibrosis. The findings suggest a shared etiology for RPF and pleural fibrosis and furthermore possibly a similar pathogenetic mechanisms.
Uibu
Toomas
T
Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland. toomas.uibu@saunalahti.fi
Järvenpää
Ritva
R
Hakomäki
Jari
J
Auvinen
Anssi
A
Honkanen
Eero
E
Metsärinne
Kaj
K
Roto
Pekka
P
Saha
Heikki
H
Uitti
Jukka
J
Oksa
Panu
P
D000368:Aged; D001194:Asbestos / Q000009:adverse effects*; D001195:Asbestosis / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D016022:Case-Control Studies; D004781:Environmental Exposure; D005260:Female; D005355:Fibrosis / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000473:pathology*; D010995:Pleural Diseases / Q000209:etiology* / Q000473:pathology; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D012185:Retroperitoneal Fibrosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed
D001194:Asbestos