Imaging and imagination in the diagnostics of asbestosis

Our plain-English summary of Imaging and imagination in the diagnostics of asbestosis, by S.M. Candura, I. Marradi (La Medicina del Lavoro, 2020).

The study

• Authors: S.M. Candura, I. Marradi
• Journal: La Medicina del Lavoro
• Published: 2020;111(5):411-412
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Two cases of asbestosis diagnosed on the basis of anamnestic, clinical, and instrumental criteria, were not confirmed by forensic autopsy ordered by the public prosecutor to ascertain the cause of death. The two cases demonstrate that a suggestive working history can be misleading, in the absence of clear radiological signs and histopathological findings, and that asbestosis must be diagnosed following the criteria consolidated in the scientific literature, as any diagnostic errors can have serious legal consequences.

In plain English

This short article reported two cases from Italy. On behalf of a public prosecutor, the authors checked at autopsy whether two men had died of asbestosis or another asbestos-related disease. Both had been diagnosed with asbestosis during life without examination of lung tissue. Both had worked in a metalworking industry from the 1960s in poor hygiene conditions without adequate protection: one as a welder for about 40 years, the other as a boilermaker for about 30 years. Both smoked 20 cigarettes a day. The first man had pleural plaques on a chest scan and was diagnosed with asbestosis on nonspecific radiological findings. His autopsy, at age 76, found pleural plaques, probably asbestos-related, but no sign of asbestosis. The second man received an INAIL annuity for "lung asbestosis with COPD", although his last chest scan showed no signs of interstitial lung disease. He died at 74 of septic shock, and autopsy showed no sign of asbestosis. The authors concluded that asbestosis must be diagnosed with caution, following established criteria, because diagnostic errors can have serious legal consequences.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Report of two cases: diagnoses of asbestosis made during life were checked against full forensic autopsy with histology, carried out for the public prosecutor's office
• Who was studied: Two men in Italy who had worked at the same metalworking plant and had been diagnosed with asbestosis during life without histopathological findings
• Exposure: Occupational asbestos exposure at a metalworking industry from the 1960s, in poor hygiene conditions without adequate personal protection: about 40 years as a welder (first man) and about 30 years as a boilermaker (second man). Fiber type and dose were not stated. Both men smoked 20 cigarettes a day.
• Main results:
  • First man: fibrocalcific pleural plaques were seen on high resolution chest tomography at age 68. At age 71 he was diagnosed with smoking-related COPD and with asbestosis based on nonspecific (aspecific) radiological findings.
  • First man (found dead at home at age 76): autopsy showed cardiomegaly, subcritical coronary artery stenosis, pulmonary anthracosis with areas of focal fibrosis, and diffuse thickening and pleural plaques (probably asbestos-related), but no macroscopic or histological sign of asbestosis.
  • Second man: during life he received an INAIL annuity for "lung asbestosis with COPD" and "severe obstructive syndrome". His latest high resolution chest tomography, a year before death, documented no signs of pulmonary interstitial disease.
  • Second man (died at 74 of septic shock in an acute abdomen): autopsy showed an ascending colon abscess, left ventricular hypertrophy with subcritical coronary stenosis, and acute pulmonary oedema with inflammatory infiltrates, but no sign of asbestosis.
• The authors' conclusion: The authors concluded that a diagnosis of asbestosis made from a suggestive work history, without indicative radiological signs or histopathological findings, was not confirmed at autopsy in these two cases. In their view the diagnosis must be made with caution, following criteria established in the scientific literature, because diagnostic errors can have serious forensic consequences.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Autopsy.

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