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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 ]
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.
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.
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]
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.
Pleural thickening - Irregularity or abnormal prominence of the pleural margin, including apical capping (thickening of the pleura in the apical region). Pleural thickening can be calcified. Diaphragmatic tenting - A localized accentuation of the normal convexity of the hemidiaphragm as if "pulled upwards by a string."
The goal of treatment with immunosuppressive agents such as corticosteroids is to decrease lung inflammation and subsequent scarring. Responses to treatment vary. Those whose conditions improve with immunosuppressive treatment probably do not have idiopathic pulmonary fibrosis, for idiopathic pulmonary fibrosis has no significant treatment or cure.
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. Treatment