Persons occupationally exposed to asbestos develop several types of diseases, including asbestosis, lung cancer, mesothelioma. Nonetheless, many source of pollution that releases significant amounts of asbestos fibers are present in any environments. The follow-up of workers occupationally exposed to asbestos and other fibers is mandatory in the work-up of persons controlled for occupational disease. Despite these needs, screening for mesothelioma and asbestos-related disease have not been sufficiently demonstrated relies on scarcely sensible procedures (Chest X Rays – CXR -, lung function tests, blood analysis); Lung High Resolution Computed Tomography –HRCT is the reference standard. Pleural plaques and pulmonary fibrosis, which can be observed early, are associated, but non the “cause” of lung cancer and mesotheliomas; moreover, repeated irradiation and invasive diagnostic procedures have not a sufficiently positive cost-benefit balance. We are challenging the use of Thoracic Ultrasound as a non-invasive, affordable, safe and repeatable screening and monitoring tool in subjects occupationally exposed to asbestos. We studied 30 workers, 23 men and 7 women (years 51-69), occupationally exposed for at least 15 years to asbestos, non-smokers and with CXR negative for pleural-pulmonary disease, normal EKG and respiratory function tests.13 subjects displayed TUS abnormalities: a) 9 irregular thickening of pleural line (above 3.0 mm), with associated micro-nodules (2-4 mm) in 2; b) 4 showed plaque nodulations (4-7 mm). By HRCT, performed in all, the 9 subjects with pleural thickening have early signs of pulmonary fibrosis, with sub-pleural and basal peribronchial reticular pattern and sub-pleural micro-nodules. Calcified plaques were observed in the 4 subjects with plaque nodules seen by TUS. Conclusion: TUS identifies early signs of lung involvement in subjects exposed to asbestos in the absence of CXR findings, and with subsequent HRCT evidence. The procedure is suitable to be appropriately performed after adequate training of the medical professionals, and preliminarily shows good sensibility and specificity.
