Asbestos plaques

Asbestos plaques

Characteristics

  1. Asbestos-related pleural plaques represent focal areas of fibrotic response in the visceral pleura to previous exposure to inhaled asbestos fibres at least 8–10 years before. Classically, they calcify (approximately 50%). Both the presence of plaques and their calcification increase with time. They spare the costophrenic angles and lung apices. In their own right they have no malignant potential; however, in some patients, asbestos exposure can lead to pulmonary fibrosis, lung cancer and mesothelioma.

Clinical features

  1. Asbestos plaques are asymptomatic. Any chest symptoms should alert the clinician to the potential complications of asbestos exposure.

Radiological features

  1. CXR – focal areas of pleural thickening (<1 cm). They are usually bilateral and may be multiple. Plaques are more visible when they calcify and calcified plaques have a thicker peripheral edge than central portion. When they are seen en-face they have an irregular ‘holly leaf ’ appearance. Non-calcified plaques seen en-face can give a patchy density to the lungs. There should be no lymphadenopathy.
  2. They are associated with rounded atelectasis or pseudotumours. On the CXRthese look like peripherally based round nodules mimicking lung neoplasms. On CT imaging they demonstrate a rounded area of lung abutting an area of pleural thickening, with a swirl of vessels (tail) leading to the peripheral-based lesion. They are completely benign and should be recognised to avoid further invasive investigations.
  3. Occasionally the pleural thickening can be diffuse, restricting lung function and mimicking mesothelioma.

Differential diagnosis

  1. There are few conditions which have a similar appearance.
  2. Previous history of TB or haemorrhagic pleural effusions can give a similar picture (more often unilateral).
  3. Exposure to amiodarone and a very rare condition of idiopathic pleural fibrosis can also produce these findings.

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Management

  1. No active management.
  2. Need to exclude complications of asbestos exposure with a supportive clinical history and possibly further imaging (CT scan).
  3. Consider follow-up, particularly if chest symptoms persist and the patient is a smoker. Pulmonary asbestosis (fibrosis secondary to asbestos exposure) increases the risk of lung cancer 40-fold if the patient is also a smoker.
  4. Consideration for industrial financial compensation.

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