A case of intractable benign asbestos pleural effusion leading to remarkable restrictive ventilatory impairment

Abstract

Background. Benign asbestos pleural effusion, diffuse pleural thickening, and rounded atelectasis are asbestos-related lung diseases. Case. A 76-year-old man who had worked in the shipbuilding industry was admitted for right pleural effusion. Chest CT showed rounded atelectasis, right pleural effusion, bilateral pleural thickening and pleural plaque in the right lower lobe. Right rounded atelectasis and collapsed fibrotic lung tissue were revealed by transbronchial lung biopsy. The right effusion was lymphocyte-predominant exudative pleural effusion. The pleural biopsy specimens obtained by VATS demonstrated fibrotic pleural thickening. As a result, diffuse pleural thickening and rounded atelectasis were diagnosed as having benign asbestos pleural effusion. One year later, the same disorder was found on the left thoracic side. Although this patient received corticosteroids and several drainage therapy treatments, the pleural effusion, pleural thickening and rounded atelectasis progressed with marked restrictive ventilatory impairment. He died of type 2 respiratory failure 3 years after his initial visit. At autopsy, extensive fibrous pleural thickening and multiple rounded atelectasis lesions were observed in both lungs. Conclusion. Because diffuse pleural thickening, rounded atelectasis lesions and benign asbestos pleural effusion can have a poor prognosis, such as this case, multilateral systemic management is desired.