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Pleural Fibrosis and Calcification

by Richard W. Light, MD

Pleural fibrosis and calcification are usually benign sequelae of pleural inflammation or asbestos exposure.

Pleural fibrosis and calcification can be either postinflammatory or asbestos related (see Asbestos-Related Pleural Disease). These disorders are suspected and diagnosed based on imaging studies.

Postinflammatory

Pleural inflammation commonly causes acute pleural thickening due to fibrosis. In most cases, the thickening resolves almost completely. Some patients are left with minor degrees of pleural thickening, which usually causes no symptoms or impairment of lung function. Occasionally, the lung becomes encased with a thick, fibrous pleural peel that limits expansion, pulls the mediastinum toward the side of disease, and impairs pulmonary function. Chest x-ray shows asymmetry of the lungs with thickened pleura (trapped lung). Differentiating localized pleural thickening from loculated pleural fluid may be difficult on x-ray, but this differentiation is easily made with CT.

Pleural fibrosis after inflammation can, on occasion, calcify. Calcification produces a dense image on the chest x-ray and almost always involves the visceral pleura. Postinflammatory calcifications are invariably unilateral.

Asbestos-related

Exposure to asbestos can lead to focal, plaquelike pleural fibrosis, at times with calcification, occurring up to 20 yr after the initial exposure. Diagnosis is usually by chest x-ray. The diameter of the plaques can vary from several millimeters to 10 cm. Any pleural or pericardial surface can be affected, but asbestos-related pleural plaques are usually in the lower two thirds of the thorax and are bilateral. Calcification most often affects the parietal and diaphragmatic pleura and spares the costophrenic sulci and apices. Calcification may be the only evidence of exposure. Dense pleural fibrosis surrounding the entire lung and >1 cm in thickness can also follow asbestos exposure.

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