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Pleural Fibrosis and Calcification

By Richard W. Light, MD, Professor of Medicine, Vanderbilt University Medical Center

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Pleural fibrosis and calcification are thickening and stiffening of the pleura (the thin, transparent, two-layered membrane that covers the lungs) that occurs as a result of pleural inflammation or exposure to asbestos.

  • Inflammation or asbestos exposure can cause the pleura to thicken and become stiff.

  • People may not have symptoms,or, if a large area of the pleura is affected, they may have difficulty breathing.

  • Diagnosis is with chest x-rays and sometimes computed tomography.

  • Sometimes surgery is needed to remove the pleura.

Usually, the pleura is very thin and flexible, but sometimes it becomes thick (develops fibrosis) as a result of

Sometimes only a small area of the pleura is affected. Other times large areas of the pleura are affected. The fibrotic pleura can also develop calcification (accumulation of calcium within the tissue).

Postinflammatory pleural fibrosis

Inflammation of the pleura causes thick fibrous tissue to replace the thin pleural membrane. In most cases, the thickening resolves almost completely once the inflammation resolves. Some people are left with minor degrees of pleural thickening, which usually causes no symptoms or impairment of lung function. Occasionally, one of the lungs becomes encased with a thick fibrous layer that limits the ability to expand and take in oxygen and impairs lung function.

Occasionally, calcifications can develop in parts of the pleura that have been affected by fibrosis.

Asbestos-related

Exposure to asbestos can lead to pleural fibrosis that affects only a small area, at times with calcification. Fibrosis and calcification can occur more than 20 years after exposure to asbestos.

Symptoms

If only a small area of a lung is affected, people may not have any symptoms. When a larger area is affected, people may have difficulty breathing because the fibrosis prevents the lungs from expanding.

Diagnosis

  • Chest x-ray

Chest x-rays are done to detect pleural fibrosis and calcification. Occasionally, computed tomography (CT) is needed.

Treatment

  • Sometimes surgical removal of the pleura

If the disorder is mild and only small parts of the pleura are affected, treatment may not be needed. When a larger part of the lung is covered with fibrosis and breathing is affected, doctors may need to do surgery to remove the fibrotic pleura.