Pleural thickening

Other names| Pleural fibrosis
Macroscopic appearance of a pleural plaque.
Specialty| Respirology

Pleural thickening is an increase in the bulkiness of one or both of the pulmonary pleurae. A severe form of the condition is known as fibrothorax.

## Contents

* 1 Causes
* 2 Pleural plaques
* 3 See also
* 4 References

## Causes

Category | Disease[1] | Features[1]

|
|

Infection | After empyema |

* Most often basolateral
* May have calcification
* Non-progressive

After tuberculosis |

* Commonly forming an apical pleural cap
* Non-progressive
* Rarely extensive, with sheet-like calcifications

Active infection with mycobacteria other than tuberculosis, or chronic pulmonary aspergillosis |

* Slowly progressive
* Apical distribution
* Cavitations

Non-infectious inflammation  | Asbestosis |

* Pleural plaques (see section below)
* Less common: Extensive confluent thickening, sometimes with pleural effusion

After pleurodesis  |

* Diffuse
* Non-progressive

After hemothorax |

* Usually basolateral distribution
* May have calcification
* Non-progressive

After drugs, such as methysergide or bromocriptine |

* Diffuse
* Possible interstitial pulmonary fibrosis

Cancer-related  | Primary cancer, mainly mesothelioma |

* Associated with asbestosis
* Progressive thickening

Metastasis or invasion, mainly from lung cancer  |

* Progressive
* Nodular changes
* Lung tumors

## Pleural plaques

Pleural plaques are patchy collections of hyalinized collagen in the parietal pleura.[2] They have a holly leaf appearance on X-ray.[1] They are indicators of asbestos exposure, and the most common asbestos-induced lesion.[3] They usually appear after 20 years or more of exposure and never degenerate into mesothelioma. They appear as fibrous plaques on the parietal pleura, usually on both sides, and at the posterior and inferior part of the chest wall as well as the diaphragm.[4]

## See also

* Pleural disease

## References

1. ↑ 1.0 1.1 1.2 Unless otherwise specified in boxes, reference is: Laura-Jane Smith; Jerry Brown; Jennifer Quint (2015). Eureka: Respiratory Medicine. JP Medical Ltd. ISBN 9781907816727.
2. ↑ Torigian, Drew A.; Lau, Charles T.; Miller, Wallace T. (2011). Chapter 68 - Pleural Diseases in Radiology Secrets Plus. pp. 478–485. doi:10.1016/B978-0-323-06794-2.00068-7.
3. ↑ "Asbestos-related pleural disease". Curr Opin Pulm Med 18 (4): 377–81. July 2012. doi:10.1097/MCP.0b013e328354acfe. PMID 22617814.
4. ↑ American Thoracic Society (September 2004). "Diagnosis and initial management of nonmalignant diseases related to asbestos". Am. J. Respir. Crit. Care Med. 170 (6): 691–715. doi:10.1164/rccm.200310-1436ST. PMID 15355871.

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