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Pleural plaques and pleural fibrosis
Pleural plaques and pleural fibrosis are the types of asbestos-related diseases.
Pleural plaques are the most common manifestation of asbestos exposure. They are smooth, white, raised, irregular lesions found on the parietal pleura, commonly located in the lateral and posterior midzones and over the diaphragms. They are frequently asymptomatic and are recognized only on chest imaging. Macroscopic calcification is common. Plaques are not associated with the development of a malignant mesothelioma. They are, however, markers of asbestos exposure, and thus individuals with pleural plaques are at risk of developing pulmonary fibrosis, mesothelioma, and lung cancer.
Pleural plaques are small, slightly raised, thickened areas on the surface of the lungs caused by inhaled asbestos dust. They often appear on both lungs, and may calcify (harden) over time. The presence of pleural plaques is one of the most significant indicators of prior exposure to asbestos, which can be important in establishing the cause of other lung diseases. They are generally considered to be benign, and do not lead to or cause other complications of asbestos exposure. However, as an indicator of asbestos exposure, they can cause considerable emotional stress, since pleural plaques indicate a heightened risk of developing other, more malignant lung conditions related to asbestos exposure.
Benign pleural plaque causes no disability or symptoms and can take at least 12 to 15 years, and often much longer, to develop from the time of exposure to asbestos to the fibres forming plaques.
Pleural Plaques have no effect upon lung function save in rare cases where exposure to asbestos must have been extensive. They may however cause anxiety in a person in that they may develop into a more serious condition.
Pleural thickening (fibrosis)
A thickening of the lining around the lungs, it is often due to exposure to asbestos. Similar to pleural plaques, it is the result of scarring of the pleural tissue due to asbestos. It shows as thickened areas of scar tissue on the lining outside the lungs. Depending on the extent of the fibrosis, it may be asymptomatic, or it may considerably affect lung functioning.
Disease confined to the pleural membranes is not asbestosis, a mistake in diagnosis frequently made by physicians reading chest x-rays. Unlike asbestosis, pleural plaques and fibrosis rarely cause symptoms or any discomfort. Sometimes calcium is deposited into these plaques, and then they are much more easily seen on chest x-ray (because calcium is so dense). Several other conditions can cause pleural scarring and calcium deposits, such as healed tuberculosis and other infections. However, a particular distribution of pleural plaques/fibrosis on the chest x-ray (for example, covering both diaphragm muscles, especially if calcified) can be attributed to asbestos, if there is a history of exposure and no other cause is evident.
Though a marker of remote asbestos exposure, plaques are sometimes difficult to diagnose on a plain chest x-ray because other shadows (particularly overlying body fat) may confuse the picture (Muller 1993). This is particularly true if the plaques are not calcified. While a chest CT scan can usually separate out pleural plaques from other shadows, CT scans are not routinely done in most asbestos claimants. Most claims filed for pleural plaques are based on the chest x-ray alone, resulting in much interpretive controversy.
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