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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.
In both CT and chest radiographs, normal lungs appear dark due to the relative lower density of air compared to the surrounding tissues. When air is replaced by another substance (e.g. fluid or fibrosis), the density of the area increases, causing the tissue to appear lighter or more grey.
The parenchyma is made up of neoplastic cells. The other compartment is the stroma induced by the neoplastic cells, needed for nutritional support and waste removal. In many types of tumour, clusters of parenchymal cells are separated by a basal lamina that can sometimes be incomplete. [14]
Pleural effusions collect in the costodiaphragmatic recess when in standing position, [2] and present on plain X-rays as "blunting" of the costophrenic angle. A thoracocentesis (pleural tap) is often performed here while a patient is in full expiration because of less risk of puncturing the lungs and thereby causing pneumothorax. [2]
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.
Histopathology of a case of chronic pulmonary congestion, showing interstitium with hemosiderin deposition (black arrow), edema and collagenous thickening. The alveolus contains a siderophage (white arrow, characterized by coarse brown pigment, which is slightly refractile). Hemosiderin image of a kidney viewed under a microscope.
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In this context, the most important assessment of the pleural fluid is the percentage by volume that is taken up by red blood cells (the hematocrit) A hemothorax is defined as having a hematocrit of at least 50% [6] of that found in the affected person's blood, although the hematocrit of a chronic hemothorax may be between 25 and 50% if ...