Division of Cardiovascular Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Rd, Xindian Dist, New Taipei City, 23143, Taiwan.
Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Rd, Xindian Dist, New Taipei City, 23143, Taiwan.
BMC Pulm Med. 2024 Aug 5;24(1):382. doi: 10.1186/s12890-024-03192-6.
Fiberglass has a larger aerodynamic diameter and is less likely to be inhaled into the lungs. Further, it will be cleared even if it is mechanically broken into smaller pieces and inhaled into the lungs. Fiberglass lung disease has been well documented if long term exposure but was thought reversible and would not cause severe diseases. The diagnosis of fiberglass lung disease depends on exposure history and histopathological findings. However, the exact occupational exposure history is often difficult to identify because mixed substance exposure often occurs and fiberglass disease is not as well-known as asbestosis.
A 66-year-old man had unexplained transudative pericardial effusion requiring pleural pericardial window operation twice at another medical center where asbestosis was told because of his self-reported long-term asbestosis exposure and the histopathological finding of a ferruginous body in his lung. Constrictive pericarditis developed two years later and resulted in congestive heart failure. Radical pericardiectomy combined with lung biopsy was performed following chest computed tomography imaging and the transudative nature of pericardial effusion not compatible with asbestosis. However, the histopathologic findings of his lung and pericardium at our hospital only showed chronic fibrosis without any asbestosis body. The patient's lung was found to be extremely fragile during a lung biopsy; histopathologic specimens were reviewed, and various fragments of fiberglass were found in the lung and pericardium. The patient's occupational exposure was carefully reevaluated, and he restated that he was only exposed to asbestosis for 1-2 years but was heavily exposed to fiberglass for more than 40 years. This misleading exposure history was mainly because he was only familiar with the dangers of asbestos. Since most fiberglass lung diseases are reversible and the symptoms of heart failure resolve soon after surgery, only observation was needed. Ten months after radical pericardiectomy, his symptoms, pleural effusion, and impaired pulmonary function eventually resolved.
Fiberglass could cause inflammation of the pericardium, resulting in pericardial effusion and constrictive pericarditis, which could be severe and require radical pericardiectomy. Exact exposure history and histopathological examinations are the key to diagnosis.
玻璃纤维具有更大的空气动力学直径，不太可能被吸入肺部。此外，即使它被机械地破碎成更小的碎片并吸入肺部，也会被清除。如果长期暴露，玻璃纤维肺病已得到充分证实，但被认为是可逆的，不会引起严重疾病。玻璃纤维肺病的诊断取决于暴露史和组织病理学发现。然而，由于混合物质暴露经常发生，而且玻璃纤维病不如石棉沉着病那么知名，因此确切的职业暴露史通常难以确定。
一名 66 岁男性因不明原因的心包渗出性积液，在另一家医疗中心接受了两次胸腔心包窗手术，因为他自述长期石棉沉着病暴露和肺部铁粒体的组织病理学发现，被诊断为石棉沉着病。两年后发展为缩窄性心包炎，并导致充血性心力衰竭。根据胸部计算机断层成像进行了根治性心包切除术和肺活检，心包渗出的性质与石棉沉着病不一致。然而，我们医院的肺和心包的组织病理学发现仅显示慢性纤维化，没有任何石棉沉着病体。在进行肺活检时，患者的肺非常脆弱；对组织病理学标本进行了审查，在肺和心包中发现了各种玻璃纤维碎片。仔细重新评估了患者的职业暴露史，他再次表示仅接触石棉沉着病 1-2 年，但接触玻璃纤维超过 40 年。这种误导性的暴露史主要是因为他只熟悉石棉的危险。由于大多数玻璃纤维肺病是可逆的，心力衰竭症状在手术后很快缓解，因此只需要观察。根治性心包切除术后 10 个月，他的症状、胸腔积液和肺功能受损最终得到缓解。
玻璃纤维可引起心包炎症，导致心包积液和缩窄性心包炎，可能很严重，需要根治性心包切除术。确切的暴露史和组织病理学检查是诊断的关键。
