Systematic overestimation and moderate interobserver agreement may compromise subjective visual grading of emphysema, which suggests that subjective visual grading should be supplemented with objective methods to achieve precise, reader-independent quantification of emphysema.

The aim of this study was to investigate by computed tomography (CT) whether asbestosis, diffuse pleural thickening and/or pleural plaques are statistically associated. We also tried to find criteria to differentiate between diffuse and circumscribed pleural thickening. From 231 exposed workers, only those subjects whose radiograph showed neither bilateral calcified pleural plaques nor small pulmonary opacities higher than 1/1 grade according to the 1980 International Labour Office (ILO) Classification were considered. Scans were assessed for the presence of subpleural curvilinear lines, septal and intralobular lines, parenchymal bands, honeycombing, rounded atelectasis, pleural plaques and diffuse pleural thickening. CT scans revealed pleural and/or lung abnormalities in 99 workers. Pleural plaques were unilateral in one-third of cases with plaques. Diffuse pleural thickening, parenchymal bands and rounded atelectasis were unilateral in, respectively, 62 and 69 and 75% of cases with the abnormality. Septal and intralobular lines, and honeycombing were always bilateral. CT signs could be grouped into three patterns: 1) septal and intralobular lines, and honeycombing corresponding to pulmonary fibrosis; 2) pleural plaques corresponding to parietal pleural fibrosis; and 3) diffuse pleural thickening, rounded atelectasis and parenchymal bands corresponding to visceral pleural fibrosis. In these workers with a normal or near-normal radiograph, three groups of subjects with different responses were distinguished. Crow's feet and rounded atelectasis help to differentiate plaques from diffuse thickening.

In all cases, low-and high-signal masses were observed on Ti-and T2-weighted images, respectively. The cysts were unilocular with a sharply defined margin, ranging from 0.5 to 3.0 cm in diameter. The thin wall was of low signal intensity on T2-weighted images. Our experience suggests that MR imaging is useful in demonstrating the liquid content of prostatic and seminal-vesicle cysts and in establishing their size and location.

P Pl le eu ur ra al l e ef ff fu us si io on n d du ur ri in ng g b br ro om mo oc cr ri ip pt ti in ne e e ex xp po os su ur re e i in n t tw wo o p pa at ti ie en nt ts s w wi it th h p pr re e--e ex xi is st ti in ng g a as sb be es st to os s p pl le eu ur ra al l p pl la aq qu ue es s: : a a r re el la at ti io on ns sh hi ip p? ? ABSTRACT: Two patients with pleural plaques developed pleural effusion and subsequent diffuse pleural fibrosis 50 and 39 yrs after their first exposure to asbestos. The diagnosis of benign asbestos pleural effusion was suggested, but the work-up finally suggested bromocriptine-induced pleural disease in both patients.These two cases illustrate that drug-induced pleural effusion is an important differential diagnosis of benign asbestos pleural effusion. It is, moreover, possible that pre-existing asbestos pleural lesions, or even asbestos exposure, increases the risk of developing bromocriptine-induced pleural disease.

To assess the reliability of computed tomography (CT) in detecting discrete pleural lesions, the interobserver and intra-observer variability in reading the conventional and high-resolution CT (HRCT) scans of 100 volunteers, who had worked for ¢10 yrs in a building with known asbestos contamination, was evaluated.In the first session, pleural abnormalities were detected by a single radiologist (A 1 ) in 13 subjects. In the second session, the scans were read again independently by the same radiologist (A 2 ) and two other experienced radiologists (B, C). The final decision for the presence of pleural lesions was made in a final consensus reading.This gave a diagnosis of pleural abnormalities in 18 subjects, of whom eight (44%) had been detected by all three readers, five (28%) by two readers and four (22%) by only one reader; one scan, rated normal by all readers during the second session, was reconsidered because pleural abnormalities had been noted at the first reading (A 1 ). The intra-observer agreement for reader A was good (kappa (k) 0.68) but the interobserver agreement between the readers was only fair to moderate (weighted k: A 2 -B~0.43, A 2 -C~0.45, B-C~0.26) in the second reading session.In conclusion, when looking for the prevalence of pleural lesions in indoor asbestos exposed subjects, the potential lack of consistency in reporting the presence of small pleural abnormalities must be borne in mind and strict precautions must be taken. Eur Respir J 2001; 17: 916-921.