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• W2532912151 abstract "SESSION TITLE: Student/Resident Case Report Poster - Occupational and Environmental Lung Diseases SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Pleuritis and pericarditis are inflammatory conditions with multiple etiologies, including infection, malignancy and autoimmune processes. Sequential presentation of these two conditions should raise concerns and alter diagnostic considerations. Such is the case of an eosinophilic pleural effusion that occurred a year after an idiopathic pericardial effusion, suggesting asbestosis as a unifying diagnosis. CASE PRESENTATION: A 53 year old male with remote light smoking history and no history of malignancy, lung disease or connective tissue disease presented with new onset, symptomatic, atrial fibrillation. He was anticoagulated on apixaban after echocardiogram showed mild MR, LA enlargement and no evidence of pericardial effusion. Weeks later, he developed increasing dyspnea and epigastric discomfort. Abdominal CT revealed a large pericardial effusion, confirmed by TTE. Pericardial window procedure revealed a hemorrhagic effusion. Pathology showed chronic inflammatory changes and fibrosis. Anticoagulation was discontinued, and he did well on 5 months of colchicine. A chest CT was ordered to evaluate recurrent cough 21 months after his first presentation and was essentially normal. Two months later, a large right pleural effusion was found after he developed increasing dyspnea. At thoracentesis, 1500 ml of amber fluid with exudative characteristics and cell count remarkable for 19% eosinophils was removed. After recurrence of pleural effusion, Pleurx catheter was placed and benign appearing plaques were noted during a VATS procedure. Pleural biopsy showed fibrous thickening and focal nodular hyperplasia of mesothelial cells. Fluid cultures were negative. ANA, CCP, AFB were negative and spirometry was consistent with restrictive disease. Further questioning indicated presumed exposure to asbestos; patient worked in water pipes that are currently in the process of asbestos removal. DISCUSSION: Asbestos exposure increases probabilities of developing pleural effusions, diffuse pleural thickening, pleural plaques, constrictive pericarditis and mesothelioma. While acute pericardial effusions related to asbestosis are very uncommon, there are several reported cases. The mechanism by which asbestos fibers penetrate the pericardium is not well understood, but pericardial effusion in the setting of previous exposure should raise concern, and asbestosis is significant in the differential diagnosis of eosinophilic pleural effusions. CONCLUSIONS: It is important to recognize that the diagnosis of asbestos related disease lies in the history. Although structural lesions are a clue, evidence of exposure and exclusion of other possible conditions are crucial. As medical professionals, we must continue to look beyond the usual and develop a comprehensive differential diagnosis for eosinophilic pleural and pericardial effusions. Reference #1: Trogrlic S, Gevenois P, Schroeven M, De Vuyst P. Pericardial effusion associated with asbestos exposure. Thorax 1997. 52: 1097-1098. DISCLOSURE: The following authors have nothing to disclose: Hector Sanchez, Robert Cortina, Marilynn Prince-Fiocco No Product/Research Disclosure Information" @default.
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• W2532912151 title "It's Not Lupus" @default.
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