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The location of the lesions is mostly in the upper lobes of the lungs, usually in a lymphatic distribution. Thickening of the pleura and interlobular septal is also evident. In addition, pleural/pericardial effusions and mediastinal fat infiltration is appreciated. Definitive diagnosis is achieved through tissue biopsy. [1]
Asbestos-related diseases are disorders of the lung and pleura caused by the inhalation of asbestos fibres. Asbestos-related diseases include non-malignant disorders such as asbestosis (pulmonary fibrosis due to asbestos), diffuse pleural thickening, pleural plaques, pleural effusion, rounded atelectasis and malignancies such as lung cancer and malignant mesothelioma.
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 ]
CT scans can more readily differentiate whether pleural thickening is due to extra fat deposition or true pleural thickening than X-rays. [3] If a fibrothorax is severe, the thickening may restrict the lung on the affected side causing a loss of lung volume. [7] Additionally, the mediastinum may be physically shifted toward the affected side. [3]
Pleural tumors may be benign (i.e. solitary fibrous tumor) or malignant in nature. Pleural mesothelioma is a type of malignant cancer associated with asbestos exposure. Under most other circumstances, pleural cancers are secondary malignancies associated with lung cancer due to its nearby location or as metastasis such as with breast cancer.
Restrictive lung diseases are a category of extrapulmonary, pleural, or parenchymal respiratory diseases that restrict lung expansion, [2] resulting in a decreased lung volume, an increased work of breathing, and inadequate ventilation and/or oxygenation. Pulmonary function test demonstrates a decrease in the forced vital capacity.
Pleural plaques (indicating asbestosis) Dilated esophagus (indicating connective tissue disease) Distal clavicular erosions (indicating rheumatoid arthritis) Extensive lymph node enlargement; Pleural effusion; Pleural thickening (indicating connective tissue disease/drugs)
Patients should, of course, be advised to return sooner if symptoms redevelop. Long-term sequelae of pleural empyema are rare but include bronchopleural fistula formation, recurrent empyema and pleural thickening, which may lead to functional lung impairment needing surgical decortication. [12]
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