PMC9117916_01
(A-B) and (C-D) are chest computed tomography (CT) images acquired at the first visit and 2 years and 4 months after the first visit, respectively. CT images acquired at the first visit show small nodules in the right upper lung fields (A) and left-sided pleural effusion and egg-shell calcification of the hilar and mediastinal lymph nodes (B). CT images acquired at the second visit show an increase in the sizes of the small nodules (C) and the amount of pleural effusion bilaterally (D).
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CT revealed left-sided pleural effusion, small nodules in the right upper lung fields (Fig. 1A), and egg-shell calcification of the hilar and mediastinal lymph nodes (Fig. 1B). CT did not show any characteristic findings of asbestos exposure, such as pleural thickening or plaques. Bilateral pleural effusion appeared, and the small nodules increased in size (Fig. 1C and D).
Electron microscopic photograph and elemental analysis using an electron probe microanalyzer equipped with wavelength dispersive spectrometer (EPMA-WDS) of the pleural fluid cell block specimen. (A) A scanning electron microscopy (SEM) image of the cell block specimen. Scale bar: 10 mum. (B) Qualitative colored EPMA-WDS image of an elemental map corresponding to the area indicated by the white rectangle within (A). Silicon, amino nitrogen, and oxygen are colored red, green, and blue, respectively. The distribution of amino nitrogen corresponds to the SEM image (A). The color overlap (red and blue) indicates the coexistence of silicon and oxygen. Scale bar: 10 mum. (C) On the left side of Fig. 2C, one-dimensional analysis of the spot where red and blue overlap, indicated by (B), yields peaks of elements on the curves detected using spectrometer crystal: lithium fluoride (green), penthaerythritol (PET, blue), and rubidium acid phthalate (RAP, red). The peaks of silicon (arrow) and oxygen (arrowhead) are detected on the curves using PET and RAP, respectively. The semiquantitative analysis on the right side of Fig. 2C shows high peaks of oxygen and silicon. Al: aluminum, Ca: calcium, Cl: chloride, Fe: iron, K: potassium, Mg: magnesium, Na: sodium, O: oxygen, P: phosphorus, S: sulfur, Si: silicon, LIF: lithium fluoride; PET: penthaerythritol; RAP: rubidium acid phthalate. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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The cell block specimen was observed by scanning electron microscopy (Fig. 2A), and elemental analysis using an electron probe microanalyzer equipped with wavelength dispersive spectrometer (JXA-8600, Nihondenshi Co., Ltd., Tokyo, Japan) revealed the coexistence of silicon and oxygen (Fig. 2B). A semiquantitative analysis showed high peaks of oxygen and silicon, suggestive of a silicon compound, potentially silicon dioxide (Fig. 2C).