Roach Huw D, Davies Gareth J, Attanoos Richard, Crane Michael, Adams Haydn, Phillips Siân
Department of Radiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
Radiographics. 2002 Oct;22 Spec No:S167-84. doi: 10.1148/radiographics.22.suppl_1.g02oc10s167.
Asbestos-related neoplastic and nonneoplastic diseases of the lungs and pleura range from pleural effusion and pleural plaques to lung cancer and malignant mesothelioma. Pleural effusions are typically hemorrhagic exudates of mixed cellularity but do not typically contain asbestos bodies. The classic distribution of pleural plaques seen on chest radiographs is the posterolateral chest wall between the seventh and tenth ribs, lateral chest wall between the sixth and ninth ribs, the dome of the diaphragm, and the mediastinal pleura. Computed tomographic (CT) findings support this distribution but also show anterior and paravertebral plaques not well shown at chest radiography. Imaging features of diffuse pleural thickening include a continuous sheet, often involving the costophrenic angles and apices, that rarely calcifies. The typical CT features of round atelectasis are of a round or oval mass that abuts the pleura, a "comet tail" of bronchovascular structures going into the mass, and thickening of the adjacent pleura. Features of asbestosis on chest radiographs include ground-glass opacification, small nodular opacities, "shaggy" cardiac silhouette, and ill-defined diaphragmatic contours. CT, however, is more sensitive in their detection. Chest radiography in patients with malignant mesothelioma may show an effusion, pleural thickening, and as the tumor progresses, a more lobulated outline. CT can help identify the disease in its early stages. Asbestos-related cancers can occur anywhere in the lungs. Recognition of the clinical, radiologic, and pathologic features of these diseases will be important for some years to come.
与石棉相关的肺部和胸膜肿瘤性及非肿瘤性疾病范围广泛，从胸腔积液和胸膜斑到肺癌和恶性间皮瘤。胸腔积液通常是具有混合细胞成分的血性渗出液，但通常不含石棉小体。胸部X线片上所见胸膜斑的典型分布是第7至10肋之间的胸壁后外侧、第6至9肋之间的胸壁外侧、膈肌顶部和纵隔胸膜。计算机断层扫描（CT）结果支持这种分布，但也显示出胸部X线片上未清晰显示的前胸壁和椎旁胸膜斑。弥漫性胸膜增厚的影像学特征包括连续的片状影，常累及肋膈角和肺尖，很少发生钙化。圆形肺不张的典型CT特征是一个与胸膜相邻的圆形或椭圆形肿块、一条进入肿块的支气管血管结构的“彗尾”以及相邻胸膜增厚。胸部X线片上石棉肺的特征包括磨玻璃样混浊、小结节状混浊、“毛糙”的心影轮廓以及模糊不清的膈肌轮廓。然而，CT在检测这些方面更敏感。恶性间皮瘤患者的胸部X线片可能显示胸腔积液、胸膜增厚，随着肿瘤进展，轮廓更呈分叶状。CT有助于在疾病早期识别。与石棉相关的癌症可发生于肺部的任何部位。在未来几年，认识这些疾病的临床、放射学和病理学特征将很重要。
