1. ASPESTOSIS Radiographic findings Ritchie O. Rosso Jr. Smd 05

2. Clinic History 88 year old male, presenting for pre-op CXR for anticipated unilateral hip replacement by Ortho No current pulmonary symptoms other than mild SOB on exertion History of CAD (3 vessel CABG in 2001) 40 pack-year smoking history; quit quite a few years ago. Worked on factory line for Dupont x 40 years.

4. Hopital course Pt. did well through surgery, but developed moderate CP with small troponin leak and was transferred to Cardiology service. Stress test done revealed low risk, and pt. subsequently discharged on 7/9/04 with long list home meds (including many pulmonary meds + O2) Had previous admission 5/01 for SOB and accumulation pulmonary fluid, after which he underwent CABG

6. Radiographic features of Aspestosis Benign pleural effusion (usually w/in 10 yrs. of exposure) Pleural plaque formation +/- calcification Pleural thickening Rounded atelectasis Pulmonary fibrosis (usually >20 yrs. after exposure) Malignant mesothelioma Bronchial carcinoma

7. Findings/diff diagnosis Nodular shadows associated with short line shadows are seen in fibrosing alveolitis whatever the cause (especially pneumoconioses such as coal workers lungs, tin handlers, aspestosis) Allergic alveolitis Late stage xanthomatous lesions (Histiocytosis X)

8. Aspestosis Amphibole fibers (straight fibers) more carcinogenic than chrysotile (curved fibers) Smokers with aspestos exposure 60-70 times more likely than nonsmokers to develop bronchogenic carcinoma

9. References/ACR code Radiology Recall. Spencer B. Gay, Richard J. Woodcock. 2000. pp. 112 Diagnosis of Diseases of the Chest. Fraser, Pare, genereux. 1989. pp.1333- 1335. ACR 66.77