Asbestos exposures: Known and underrecognized sources

Abstract

We would like to report on a case of mesothelioma in a patient with a wellknown source of asbestos exposure, as well as an unusual exposure source.IM was a 72-year-old white male with a 60 pack-year smoking history, and multiple medical problems including diabetes, hypertension, renal insufficiency, coronary artery disease, and peripheral vascular disease. He was referred to our hospital in early 1991 with a 2-month history of progressive dyspnea, night sweats, fever, cough, and pleuritic chest pain. This referral followed unsuccessful treatment for decompensated congestive heart failure and diagnostic aspiration of both cytology and culture negative, serosanguinous pleural fluid.Review of the chest radiograph confirmed the presence of previously noted calcified pleural plaques on the left and diffuse pleural thickening with effusion on the right. These findings were also noted on subsequent computerized tomography scan. The latter was suggestive of parenchymal asbestos-related fibrosis as well. Repeat thoracentesis produced cytology suspicious for adenocarcinoma. The patient was deemed high risk for thoracotomy and for open lung biopsy due to his multiple medical problems. He died soon thereafter and a diagnosis of mesothelioma was made.Review of his occupational history revealed probable asbestos exposure as a shipyard welder during World War 11. However, further investigation disclosed daily washing machine maintenance activities as an operator of a laundromat from 1966 through 198 1. He would disassemble and sand the clutch lining on these units in order to "keep the tub from spinning out of sequence." Actual availability of one of these clutch assembly linings resulted in analysis confirming the presence of 10-12% chrysotile asbestos. The washer manufacturer later confirmed use of asbestos for this purpose until 1980.Although the patient's shipyard exposure most likely explains the findings in this case, daily exposure from the washer clutch assemblies cannot be overlooked.Address reprint requests to Dr.

Asbestosis and small cell lung cancer in a clutch refabricator.

“…1- 3 5 Few studies exist about exposure to friction products of asbestos during maintenance or repair after use. 4 11 There are case reports of pleural mesothelioma diagnosed in a laundry owner handling washing machine clutches 6 and in a brake repair worker. 12 In both cases, the presence of chrysotile asbestos in the lung tissue was confirmed by electron microscopy and energy dispersive analysis.…”

“…There are few data available on exposures after use or during refabrication particularly when this process involves clutch components. 6 In the present report, material easily freed from worn clutches such as those used in the workplace in question were analysed. The worker's illness attributed to exposure to asbestos from refabricating clutches is discussed, with ultrastructural analysis of lung tissue and clutch surface extracts.…”