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
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].
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