Asbestos-Related Rounded Atelectasis

Radiologic and Mineralogic Data in 23 Cases
      A retrospective study was conducted in 23 subjects with previous occupational exposure to asbestos and exhibiting rounded atelectasis (RA) on high-resolution computed tomography scan (HRCT scan) to evaluate the retention of asbestos bodies (ABs) using light microscopy in the bronchoalveolar lavage (BAL) fluid or lung parenchyma in such patients. A total of 31 RAs were identified, usually located in the lower (25 RAs) and posterior (23 RAs) parts of the lung. Pleural thickening in contact with the RA was observed in 27 RAs and parenchymal bands were detected in 15 cases. Twelve of the 20 patients who underwent BAL or surgery exhibited significant retention of ABs in BAL fluid or lung tissue. Moreover, a significant retention of ABs was observed in five of nine patients with a history of asbestos exposure but no diffuse pleural thickening on chest radiograph or interstitial opacities on HRCT scan. Patients with RAs and coexisting diffuse pleural thickening and/or interstitial fibrosis should be considered at a higher risk for lung cancer in comparison to patients with isolated circumscribed pleural plaques based on increased AB counts. By contrast, the excess risk of lung cancer is more questionable in patients with only RAs and circumscribed pleural plaques as they may have AB counts either above or below that associated with pleural plaques alone. This emphasizes the need for further follow-up studies to define criteria indicating the need for thoracotomy in these subjects.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to CHEST
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Miller Jr, WT
        • Gupta PK
        • Grippi MA
        • et al.
        Rounded atelectasis: diagnosis by fine-needle aspiration cytology.
        Diagn Cytopathol. 1992; 8: 617-620
        • Hanke R
        • Kretzschmar R
        Round atelectasis.
        Semin Roentgenol. 1980; 25: 174-182
        • Blesovsky A
        The folded lung.
        Br J Dis Chest. 1966; 60: 19-22
        • Schneider HJ
        • Felson B
        • Gonzales L
        Rounded atelectasis.
        AJR. 1980; 134: 225-232
        • Mintzer RA
        • Gore RM
        • Robert LV
        Rounded atelectasis and its association with asbestos-induced pleural disease.
        Radiology. 1981; 139: 567-570
        • Stephenson N
        • Price J
        CT appearances of rounded atelectasis.
        Australas Radiol. 1992; 36: 308-312
        • Sébastien P
        • Armstrong B
        • Monchaux G
        • et al.
        Asbestos bodies in bronchoalveolar lavage fluid and in lung parenchyma.
        Am Rev Respir Dis. 1988; 137: 75-78
        • Siemiatycki J
        • Dewar R
        • Lakhani R
        • et al.
        Cancer risks associated with 10 inorganic dusts: results from a case-control study in Montreal.
        Am J Ind Med. 1989; 16: 547-567
      1. International Labour Office. Guidelines for the use of ILO international classification of radiographs of pneumoconiosis, revised ed. Geneva: Occupational Safety and Health Series 22, ILO, 1980, 1-48

        • Aberle DR
        • Gamsu G
        • Ray CS
        High-resolution CT of benign asbestos disease: clinical and radiographic correlation.
        AJR. 1988; 151: 883-891
        • Genevois PA
        • De Vuyst P
        • Vande Weyer R
        Tomodensitométrie des pathologies thoraciques de l’amiante.
        Rev Im Med. 1991; 3: 471-480
        • Hillerdal G
        Non-malignant asbestos pleural disease.
        Thorax. 1981; 36: 669-675
        • Craighead JF
        • Abraham JL
        • Churg A
        • et al.
        The pathology of asbestos-associated diseases of the lungs and pleural cavities: diagnostic criteria and proposed grading schema.
        Arch Pathol Lab Med. 1982; 106: 544-596
        • Roggli VL
        • Pratt PC
        • Brody AR
        Analysis of tissue mineral fiber content.
        in: Roggli VL Greenberg SD Pratt PC Pathology of asbestos-associated diseases. Little, Brown & Co, Boston1992: 299-344
        • Warnock ML
        • Prescott BT
        • Kuwahara TJ
        Numbers and types of asbestos fibers in subjects with pleural plaques.
        Am J Pathol. 1982; 109: 37-46
        • Stephens M
        • Gibbs AR
        • Pooley FD
        • et al.
        Asbestos-induced diffuse pleural fibrosis: pathology and mineralogy.
        Thorax. 1987; 42: 583-588
        • Gylseth B
        • Mowe G
        • Skaug V
        • et al.
        Inorganic fibers in lung tissue from patients with pleural plaques or malignant mesothelioma.
        Scand J Work Environ Health. 1981; 7: 109-113
        • Churg A
        Asbestos-fibers and pleural plaques in a general autopsy population.
        Am J Pathol. 1982; 109: 88-96
        • Whitwell F
        • Scott J
        • Grimshaw M
        Relationship between occupations and asbestos-fibre content of the lungs in patients with pleural mesothelioma, lung cancer, other disease.
        Thorax. 1977; 32: 377-386
        • Warnock ML
        • Kuwahara TJ
        • Wolery G
        The relation of asbestos burden to asbestosis and lung cancer.
        Pathol Annu. 1983; 18: 109-145
        • Wagner JC
        • Moncrieff CB
        • Coles R
        • et al.
        Correlation between fibre content of the lungs and disease in naval dockyard workers.
        Br J Ind Med. 1986; 43: 391-395
        • Ashcroft T
        • Heppleston G
        The optical and electron microscopic determination of pulmonary asbestos fibre concentration and its relation to the human pathological reaction.
        J Clin Pathol. 1973; 26: 224-234
        • Dernevik L
        • Gatzinsky P
        • Hultman E
        • et al.
        Shrinking pleuritis with atelectasis.
        Thorax. 1982; 37: 252-258
        • Menzies R
        • Fraser R
        Rounded atelectasis: pathologic and pathogenetic features.
        Am J Surg Pathol. 1987; 11: 674-681
        • Chung-Park M
        • Tomashefski JF
        • Cohen AM
        Shrinking pleuritis with lobar atelectasis: a morphologic variant of ‘rounded atelectasis.’.
        Hum Pathol. 1989; 20: 382-387
        • Carvalho PM
        • Carr DH
        Computed tomography of folded lung.
        Clin Radiol. 1990; 41: 86-91
        • Doyle TC
        • Lawler GA
        CT features of rounded atelectasis of the lung.
        AJR. 1984; 143: 225-228
        • Tylen U
        • Nilsson U
        Computed tomography in pulmonary pseudotumours and their relation to asbestos exposure.
        J Comput Assist Tomogr. 1982; 6: 229-237
        • Szydlowsky GW
        • Cohn HE
        • Steiner RM
        • et al.
        Rounded atelectasis: a pulmonary pseudotumor.
        Ann Thorac Surg. 1992; 53: 817-821
        • Aberle DR
        High resolution computed tomography of asbestos-related diseases.
        Semin Roentgenol. 1991; 26: 118-131
        • Lynch DA
        • Gamsu G
        • Ray CS
        • et al.
        Asbestos-related focal lung masses: manifestations on conventional and high resolution CT scans.
        Radiology. 1988; 169: 603-607
        • Dernevik L
        • Gatzinsky P
        Long-term results of operation for shrinking pleuritis with atelectasis.
        Thorax. 1985; 40: 448-452
        • Roggli VL
        Human disease consequences of fiber exposures: a review of human lung pathology and fiber burden data.
        Environ Health Perspect. 1990; 88: 295-303
        • Orlowski E
        • Pairon JC
        • Ameille J
        • et al.
        Pleural plaques, asbestos exposure, and asbestos bodies in bronchoalveolar lavage fluid.
        Am J Ind Med. 1994; 26: 349-358
        • Hillerdal G
        Rounded atelectasis: clinical experience with 74 patients.
        Chest. 1989; 95: 836-841