Imaging of pleural plaques, thickening, and tumors
- Paul Stark, MD
Paul Stark, MD
- Professor of Radiology
- University of California San Diego
- Section Editors
- Nestor L Muller, MD, PhD
Nestor L Muller, MD, PhD
- Section Editor — Pulmonary Imaging
- Professor of Radiology
- University of British Columbia
- V Courtney Broaddus, MD
V Courtney Broaddus, MD
- Section Editor — Pleural Disease
- Professor of Medicine
- University of California San Francisco
- Deputy Editors
- Geraldine Finlay, MD
Geraldine Finlay, MD
- Deputy Editor — Pulmonary, Critical Care, and Sleep Medicine
- Associate Professor
- Tufts University School of Medicine
- Susanna I Lee, MD, PhD
Susanna I Lee, MD, PhD
- Associate Professor of Radiology
- Harvard Medical School
- Massachusetts General Hospital
Imaging procedures are commonly used in the diagnostic evaluation of pleural abnormalities. The imaging of pleural plaques, diffuse pleural thickening, and pleural tumors will be reviewed here. The imaging of pleural effusions and pneumothorax are discussed separately. (See "Imaging of pleural effusions in adults" and "Imaging of pneumothorax".)
Pleural plaques are deposits of hyalinized collagen fibers in the parietal pleura. They are indicative of asbestos exposure and typically become visible twenty or more years after the inhalation of asbestos fibers, although latency periods of less than 10 years have been observed [1-3].
Pleural plaques are presumed to be the result of pleural inflammation caused by asbestos fibers that are transported to the pleural surface along lymphatic channels and/or direct penetration [4,5]. The former may explain why pleural plaques tend to be located near the stomata where asbestos fibers are resorbed by lymphatic flow (ie, Kampmeier's foci) . (See "Asbestos-related pleuropulmonary disease".)
Pleural plaques preferentially involve the parietal pleura adjacent to ribs, particularly the sixth through ninth ribs. They are also common along the diaphragmatic pleura. Pleural plaques are less extensive in the intercostal spaces, only rarely occur in the visceral pleura, and are conspicuously absent in the region of the costophrenic sulci and the lung apices (image 1 and image 2 and image 3).
Calcifications within pleural plaques are identified by chest radiography in 20 percent of patients (image 4 and image 3), by computed tomography (CT) in 50 percent (image 5A-B and image 6), and by morphological examination of autopsy and biopsy specimens in 80 percent [2,6-8].
- Larson TC, Meyer CA, Kapil V, et al. Workers with Libby amphibole exposure: retrospective identification and progression of radiographic changes. Radiology 2010; 255:924.
- Light RW. Pleural diseases, Lea & Febiger, Philadelphia 1983.
- Gottschall EB, Newman L. Benign asbestos-related pleural disease. In: Lung Biology in Health and Disease: Pleural Disease, 2nd, Bouros D. (Ed), Informa Healthcare, New York 2010. p.504.
- Sargent EN, Jacobson G, Gordonson JS. Pleural plaques: a signpost of asbestos dust inhalation. Semin Roentgenol 1977; 12:287.
- American Thoracic Society. Diagnosis and initial management of nonmalignant diseases related to asbestos. Am J Respir Crit Care Med 2004; 170:691.
- Müller NL. Imaging of the pleura. Radiology 1993; 186:297.
- Aberle DR, Balmes JR. Computed tomography of asbestos-related pulmonary parenchymal and pleural diseases. Clin Chest Med 1991; 12:115.
- Stark P. The Pleura. In: Radiology: Diagnosis, Imaging, Intervention, Taveras, Ferrucci (Eds), Lippincott, Philadelphia 2000.
- Sargent EN, Boswell WD Jr, Ralls PW, Markovitz A. Subpleural fat pads in patients exposed to asbestos: distinction from non-calcified pleural plaques. Radiology 1984; 152:273.
- McLoud TC. CT and MR in pleural disease. Clin Chest Med 1998; 19:261.
- Vix VA. Extrapleural costal fat. Radiology 1974; 112:563.
- Lee YC, Runnion CK, Pang SC, et al. Increased body mass index is related to apparent circumscribed pleural thickening on plain chest radiographs. Am J Ind Med 2001; 39:112.
- Pairon JC, Laurent F, Rinaldo M, et al. Pleural plaques and the risk of pleural mesothelioma. J Natl Cancer Inst 2013; 105:293.
- Leung AN, Müller NL, Miller RR. CT in differential diagnosis of diffuse pleural disease. AJR Am J Roentgenol 1990; 154:487.
- Aberle DR, Gamsu G, Ray CS. High-resolution CT of benign asbestos-related diseases: clinical and radiographic correlation. AJR Am J Roentgenol 1988; 151:883.
- Downer NJ, Ali NJ, Au-Yong IT. Investigating pleural thickening. BMJ 2013; 346:e8376.
- Cox CW, Rose CS, Lynch DA. State of the art: Imaging of occupational lung disease. Radiology 2014; 270:681.
- Schwartz DA, Fuortes LJ, Galvin JR, et al. Asbestos-induced pleural fibrosis and impaired lung function. Am Rev Respir Dis 1990; 141:321.
- Walker CM, Takasugi JE, Chung JH, et al. Tumorlike conditions of the pleura. Radiographics 2012; 32:971.
- Ahuja J, Kanne JP, Meyer CA, et al. Histiocytic disorders of the chest: imaging findings. Radiographics 2015; 35:357.
- Zen Y, Inoue D, Kitao A, et al. IgG4-related lung and pleural disease: a clinicopathologic study of 21 cases. Am J Surg Pathol 2009; 33:1886.
- Choi IH, Jang SH, Lee S, et al. A Case Report of IgG4-Related Disease Clinically Mimicking Pleural Mesothelioma. Tuberc Respir Dis (Seoul) 2014; 76:42.
- Porcel JM, Hernández P, Martínez-Alonso M, et al. Accuracy of fluorodeoxyglucose-PET imaging for differentiating benign from malignant pleural effusions: a meta-analysis. Chest 2015; 147:502.
- Shuman LS, Libshitz HI. Solid pleural manifestations of lymphoma. AJR Am J Roentgenol 1984; 142:269.
- Kim YK, Lee HY, Lee KS, et al. Dry pleural dissemination in non-small cell lung cancer: prognostic and diagnostic implications. Radiology 2011; 260:568.
- Postmus PE, Brambilla E, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for revision of the M descriptors in the forthcoming (seventh) edition of the TNM classification of lung cancer. J Thorac Oncol 2007; 2:686.
- Imai K, Minamiya Y, Ishiyama K, et al. Use of CT to evaluate pleural invasion in non-small cell lung cancer: measurement of the ratio of the interface between tumor and neighboring structures to maximum tumor diameter. Radiology 2013; 267:619.
- Schiffman SR, Datta V, Wandtke J, Hobbs SK. Imaging features of chest wall tumors. Contemporary disgnostic radiology (CDR) 2012; 35:1.
- Alexander E, Clark RA, Colley DP, Mitchell SE. CT of malignant pleural mesothelioma. AJR Am J Roentgenol 1981; 137:287.
- Grant DC, Seltzer SE, Antman KH, et al. Computed tomography of malignant pleural mesothelioma. J Comput Assist Tomogr 1983; 7:626.
- Mirvis S, Dutcher JP, Haney PJ, et al. CT of malignant pleural mesothelioma. AJR Am J Roentgenol 1983; 140:665.
- Wang ZJ, Reddy GP, Gotway MB, et al. Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. Radiographics 2004; 24:105.
- Nickell LT Jr, Lichtenberger JP 3rd, Khorashadi L, et al. Multimodality imaging for characterization, classification, and staging of malignant pleural mesothelioma. Radiographics 2014; 34:1692.
- Stark P. [Fibrous pleural mesothelioma (pleura fibroma) -- a contribution to the differential diagnosis of pleural tumours (author's transl)]. Rofo 1981; 134:614.
- Desser TS, Stark P. Pictorial essay: solitary fibrous tumor of the pleura. J Thorac Imaging 1998; 13:27.
- Valenzuela Membrives M, Cassini Gómez de Cádiz L, Cueto Ladròn de Guevara A, García Pacheco M. [Pleura solitary fibrous tumor associated with Doege-Potter Syndrome]. Pneumologie 2013; 67:340.