Metsovo Lung: History of Population Environmental Exposure

  • C. Sxiza Specialezed Occupational Medicine, Dept Public Health Policy, School of Public Health, University of West Attica
  • N. Zagorianakou Assistant professor (elect), Department of Nursing, University of Ioannina
  • C. Vlami Pneumologist, PhDc, Dept Public Health Policy, School of Public Health, University of West Attica
  • G. Farantos Postdoc Dept Public Health Policy, School of Public Health, University of West Attica
  • V. Rapisarda Professor Occupational Medicine, University di Catania
  • G. Dounias Professor Occupational & Environmental Health, Dept Public Health Policy, School of Public Health, University of West Attica
Keywords: Metsovo lung, ,mesothelioma, asbestos, tremolite


The historical course of the Metsovo Lung phenomenon began to be investigated in the 1980s when extensive pleural calcifications causing malignant mesothelioma appeared at a high frequency beyond expectation. It was not possible to explain their frequency. This finding reasonably raised the question of whether it was indeed tuberculous pleurisy or something else. The biopsies carried out confirmed that these were tremolite asbestos fibres. These fibres were derived from a shielding material containing asbestos. This is a global phenomenon according to which the entire population of Metsovo was exposed to asbestos, without knowing it, from a traditional shielding material. The abandonment of the material and its non-use brought about a gradual reduction of the phenomenon, which also marks the reduction of mesothelioma.


Download data is not yet available.


Metrics Loading ...


1. E Gogou, C Hatzoglou, D Siachpazidou… Asbestos Ban Policies and Mesothelioma Mortality in Greece - 2023 - …
2. DR Rey Asbestosis no ocupacional: un riesgo potencial a tener en consideración - Revista americana de medicina respiratoria, 2022 - SciELO Argentina
3. C Ricchiuti, A Bloise, R Punturo Occurrence of asbestos in soils: state of the art - Episodes Journal of International …, 2020 -
4. E Manos, N Palatianos, P Panagou " Metsovo Lung" with benign pleural calcifications: A CXR image with complimentary information from Ultrasound Elastography. - Pneumon, 2019 -
5. E Gogou, C Hatzoglou, SG Zarogiannis, F Malli… Mesothelioma mortality rates in Greece for the period 2005–2015 is increased compared to previous decades - Medicina, 2019 - …
6. Tzilas V, Tzouvelekis A, Bouros D. Metsovo Lung: A Story of Episteme, Techne, and Phronesis. Respiration. 2017;94(6):491-492. doi: 10.1159/000481291. Epub 2017 Oct 13.PMID: 29024926 Free article.
7. MI Velasco-Garcia, MJ Cruz, C Diego, MA Montero…First identification of pulmonary asbestos fibres in a Spanish population - Lung, 2017 – Springer
8. Gogali A, Ntzani EE, Manda-Stachouli C, Peristeri S, Tzarouchi L, Laiou E, Konstantinidis A, Constantopoulos SH, Dalavanga Y Evidence Suggesting the End of Universal Domestic Asbestos Exposure in Metsovo, NW Greece..Respiration. 2017;94(6):510-517. doi: 10.1159/000480151. Epub 2017 Oct 12. PMID: 29020669 Free article.
9. Constantopoulos SH: Metsovo Lung. A medical detective story with a happy ending. Pneumon 2014;27(suppl 1):31-41.
10. Gogali A, Manda-Stachouli C, Ntzani EE, et al: Malignant mesothelioma in Metsovo, Greece, from domestic use of asbestos: 30 years later. Eur Res J 2012;39:1
11. KI Gourgoulianis - Lessons from the investigation of" Metsovo Lung [Πνεύμων Μετσόβου], 2014 - Citeseer …
12. Bouros D Metsovo Lung. Case closed Pneumon 2014;27(suppl 1):26.
13. Goldberg M, Luce D.The health impact of nonoccupational exposure to asbestos: what do we know? Eur J Cancer Prev. 2009 Nov;18(6):489-503. doi: 10.1097/CEJ.0b013e32832f9bee.PMID: 19617842 Free PMC article. Review.
14. DT Archimandriti, YA Dalavanga, R Cianti… Proteome analysis of bronchoalveolar lavage in individuals from Metsovo, nonoccupationally exposed to asbestos - Journal of Proteome …, 2009 - ACS Publications
15. Constantopoulos SH. Environmental mesothelioma associated with tremolite asbestos: lessons from the experiences of Turkey, Greece, Corsica, New Caledonia and Cyprus.. Regul Toxicol Pharmacol 2008; 52: 110–115
16. Raptis L, Efpraxia M, Akritidis N. Primary malignant peritoneal mesothelioma associated with Metsovo lung. JBR-BTR. 2007 May-Jun;90(3):204-5.PMID: 17696098 No abstract available.
17. Darcey DJ, Alleman T Occupational and environmental exposure to asbestos. In: Roggli VL, Oury TD, Sporn ThA, eds. Pathology of Asbestos-Associated Diseases2nd Edn. Springer, New York, 2004; pp. 17–33.
18. Manda-Stachouli C, Dalavanga Y, Daskalopoulos G, Leontaridi C, Vassiliou M, Constantopoulos SH. Decreasing prevalence of pleural calcifications among Metsovites with nonoccupational asbestos exposure.Chest. 2004 Aug;126(2):617-21. doi: 10.1378/chest.126.2.617.PMID: 15302752
19. Galani V, Constantopoulos S, Manda-Stachouli C, Frangou-Lazaridis M, Mavridis A, Vassiliou M, Dalavanga Y. Additional proteins in BAL fluid of Metsovites environmentally exposed to asbestos: more evidence of "protection" against neoplasia? Chest. 2002 Jan;121(1):273-8. doi:10.1378/chest.121.1.273. PMID: 11796462
20. Senyig˘it A, Babayig˘it C, Go¨kirmak M, et al Incidence of malignant pleural mesothelioma due to environmental asbestos fiber exposure in the southeast of Turkey Respiration 2000; 67: 610–614.
21. Hillerdal G. Mesothelioma: cases associated with non-occupational and low dose exposures.. Occup Environ Med 1999; 56: 505–513
22. Sakellariou K, Malamou-Mitsi V, Haritou A, Koumpaniou C, Stachouli C, Dimoliatis ID, Constantopoulos SH. Malignant pleural mesothelioma from nonoccupational asbestos exposure in Metsovo (north-west Greece): slow end of an epidemic? Eur Respir J. 1996 Jun;9(6):1206-10. doi: 10.1183/09031936.96.09061206.PMID: 8804939
23. Shevas AT, Kastanioudakis IG, Constantopoulos SH, Assimakopoulos DA. Acquired nasopharyngeal obstruction and "Metsovo lung". Rhinology. 1995 Dec;33(4):240-3.PMID: 8919220
24. Papiris SA, Maniati MA, Sakellariou K, Gosios C, Kontogiannis D, Constantopoulos SH. Round atelectasis and Metsovo lung. Chest. 1993 Jun;103(6):1759-62. doi: 10.1378/chest.103.6.1759.PMID: 8404097
25. Constantopoulos SH, Dalavanga YA, Sakellariou K, Goudevenos J, Kotoulas OB.Lymphocytic alveolitis and pleural calcifications in nonoccupational asbestos exposure. Protection against neoplasia? Am Rev Respir Dis. 1992 Dec;146(6):1565-70. doi: 10.1164/ajrccm/146.6.1565.PMID: 1456576
26. Constantopoulos SH, Theodoracopoulos P, Dascalopoulos G, Saratzis N, Sideris K. Metsovo lung outside Metsovo. Endemic pleural calcifications in the ophiolite belts of Greece. Chest. 1991 May;99(5):1158-61. doi: 10.1378/chest.99.5.1158.PMID: 2019171
27. Gibbs AR, Role of asbestos and other fibres in the development of diffuse malignant mesothelioma. Thorax. 1990; 45: 649-654 View in Article Scopus (65) PubMed Crossref Google Scholar
28. Zerva LV, Constantopoulos SH, Moutsopoulos HM. Humoral immunity alterations after environmental asbestos exposure. Respiration. 1989;55(4):237-41. doi: 10.1159/000195740. PMID: 2595107
29. Sichletides L Dascalopoulou E Chloros D Vlachogiannis M Chatzidimitriou N Michailides K Kontos D. Pleural asbestosis in rural population of the area of Pella, Presented at the Fourth Medical Conference of Northern Greece 1989, Thessaloniki, May, Abstract 106 (Greek) View in Article Google Scholar
30. Theodorakopoulos P, Constantopoulos SH. Endemic pleural calcifications in Greece. Seventh Congress of European Society of Pulmonology. Budapest, September, 1988. European Respiratory Journal, Abstract Book, p. 292S View in Article Google Scholar
31. Baris YI, Bilir N, Artvinli M, Sahin AA, Kalyoncu F, Sebastien P An epidemiological study in an Anatolian village environmentally exposed to tremolite asbestos. .Br J Ind Med. 1988 Dec;45(12):838-40. doi: 10.1136/oem.45.12.838.PMID: 2851315 Free PMC article. No abstract available.
32. Constantopoulos SH, Langer AM, Saratzis N, et al Regional findings in Metsovo Lung. Lancet 1987;2:452-453.
33. Baris YI, Simonato M, Artvinli M, et al. Epidemiological and environmental evidence of the health effects of exposure to erionite fibres: a four year study in the Cappadocian region of Turkey Int J Cancer 1987; 39: 10–17.
34. Constantopoulos SH, Langer AM, Saratzis N, Nolan RP. Regional findings in Metsovo lung. Lancet. 1987 Aug 22;2(8556):452-3. doi: 10.1016/s0140-6736(87)90985-8.PMID: 2887751
35. Langer AM, Nolan RP, Constantopoulos SH, Moutsopoulos HM. Association of Metsovo lung and pleural mesothelioma with exposure to tremolite-containing whitewash. Lancet. 1987 Apr 25;1(8539):965-7. doi: 10.1016/s0140-6736(87)90305-9.PMID: 2882352
36. Constantopoulos SH, Malamou-Mitsi V, Goudevenos J, Papathanasiou MP, Pavlidis NA, Papadimitriou CS High incidence of malignant pleural mesothelioma in neighlxmring villages of Northwest Greece. Respiration. 1987; 51: 266-271 View in Article Scopus (46) PubMed Crossref Google Scholar
37. Constantopoulos SH, Saratzis NA, Goudevenos JA, Kontogiannis D, Karantanas A, Katsiotis P. Tremolite whitewashing and pleural calcifications. Chest. 1987; 92: 709-712 View in Article Scopus (32) PubMed Crossref Google Scholar
38. Constantopoulos SH, Goudevenos JA, Saratzis N, Langer AM, Selikoff IJ, Moutsopoulos HM. Metsovo lung: pleural calcification and restrictive lung function in northwestern Greece. Environmental exposure to mineral fiber as etiology. Environ Res. 1985 Dec;38(2):319-31. doi: 10.1016/0013-9351(85)90096-9.PMID: 4065080
39. Grant DC Seltzer SE, Antman KH, Finberg HJ, Koster K. Computed tomography of malignant pleural mesothelioma. J Comput Assist Tomog. 1983; 7: 626-632 View in Article Scopus (31) PubMed Crossref Google Scholar
40. Rabinowitz JG, Efremidis SG, Cohen B, Dan S Efremidis A, Chahinian AP et al. A comparative study of mesothelioma and asbestosis using computed tomography and conventional chest radiography. Diagn Radiol. 1982; 144: 453-460 View in Article Google Scholar
41. Bazas T, Bazas B, Kitas D, Gilson JC, McDonald JC Pleural calcification in northwest Greece. Lancet. 1981; 1: 254 View in Article , Scopus (19), Abstract, Google Scholar
42. Davis YI, Saracci R, Simonato L, Skidmode JW Malignant mesothelioma and radiologic chest abnormalities in two villages of central Turkey. Lancet. 1981; 1: 984-987, View in Article, Google Scholar
43. Navratil M, Trippe F. Prevalence of pleural calcifications in persons exposed to asbestos dust, and in the general population in the same district. Environm Res. 1972; 5: 210-216 View in Article, Scopus (23) Crossref Google Scholar
44. Burilkov T, Machailova L. Asbestos content of the soil and endemic pleural asbestosis. Environm Res. 1970; 3: 443-449 View in Article Scopus (47) Crossref Google Scholar
How to Cite
Sxiza, C., Zagorianakou, N., Vlami, C., Farantos, G., Rapisarda, V., & Dounias, G. (2024). Metsovo Lung: History of Population Environmental Exposure. European Scientific Journal, ESJ, 28, 109. Retrieved from
ESI Preprints