ASBESTOS PLAQUES IN A TYPICAL VETERANS HOSPITAL POPULATION

Previous authors have described several pleural abnormalities on chest radiography as being pathognomonic for asbestos exposure. We sought t o determine the percentage of admissions and outpatient at a typical V eteran's Affairs hospital with these findings, and research medical re cords to verify the frequency at which patients having positive radiog raphs were suspected either by clinical/occupational history or radiol ogically to have had prior significant exposure to asbestos. Radiograp hs of 1,212 consecutive patients were evaluated by a certified B reade r, and the medical records as well as previous radiology reports of al l positive patients were reviewed. Twenty-eight (2.3%) of the radiogra phs had pleural abnormalities consistent with asbestos exposure, with the patients, all male, ranging in age from 50 to 98 years (mean 75.6) . Radiology reports described pleural plaques in only 12 of the 21 (57 %) cases with prior exams available; in only seven (33%) was an asbest os etiology considered by the interpreting radiologist. The plaques we re misdiagnosed in four instances as being indicative of other, unrela ted pathology. A history of known dust exposure was expressed by only five patients (18%). Eleven described working in occupations now known to have a high incidence of exposure, but neither patient nor examini ng physician expressed consideration of dust inhalation. In conclusion , we have found that a significant percentage of patients in certain s ubpopulations show radiographic evidence of asbestos exposure that may be a harbinger of related pathology. Unfortunately, because of a low index of suspicion, thorough environmental histories are often deferre d, many radiographic changes are either not recognized or are misdiagn osed, and these patients are not followed with the stringent protocols they deserve. (C) 1996 Wiley-Liss, Inc.