Calcified plaque in the superior portion of the major fissure. An unusual manifestation of asbestos exposure

Our plain-English summary of Calcified plaque in the superior portion of the major fissure. An unusual manifestation of asbestos exposure, by S.B. Rupp, H. Jolles (Chest, 1989).

The study

• Authors: S.B. Rupp, H. Jolles
• Journal: Chest
• Published: 1989;96(6):1436-7
• Type of article: Case report
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000153).

Abstract

Parietal pleural plaque is a well-recognized sign of exposure to asbestos. Visceral pleural involvement is an uncommon manifestation, and calcified visceral pleural plaques are rare. Those reported have been in the minor fissure and inferior major fissure. We describe a unique calcified plaque in the superior major fissure.

In plain English

This was a case report describing one patient. He was a 63-year-old man who came to hospital with severe back pain; later tests found malignant histiocytic lymphoma involving the spine. He had been exposed to asbestos during a 40-year career as a railroad worker. The article does not name the type of asbestos. Chest X-rays showed plaque along the right chest wall and the diaphragm. They also showed a dense oval mass in the middle of the right chest, lined up with the major fissure, the groove between lung lobes. A CT scan showed that the mass was calcified and confirmed that it lay in the fissure. The scan also showed calcified plaque on the lining of the back and side chest walls and on both halves of the diaphragm. The authors called the fissure plaque unique in two ways. It sat in the upper part of the major fissure rather than the lower part, and it was separate from where the lung's lining meets the chest wall lining. The authors concluded that both features were visible on plain X-ray in retrospect, but that the CT scan was key to confirming the diagnosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: one 63-year-old man who presented to hospital with severe back pain; subsequent investigations found vertebral involvement by malignant histiocytic lymphoma (Department of Radiology, Medical College of Virginia, Richmond)
• Exposure: asbestos exposure during a 40-year career as a railroad worker; fiber type not stated
• Main results:
  • Admission chest X-rays showed hyperinflated lungs with peribronchial thickening and plaque along the right lateral chest wall and the hemidiaphragms
  • A dense ovoid mass was seen in the middle of the right chest; on the lateral view it projected along the plane of the major fissure
  • CT scan showed calcification within the mass and confirmed that it was located in the fissure
  • CT also showed calcified parietal pleural plaque along the posterolateral chest walls and in both hemidiaphragms
  • The authors described the fissure plaque as unique because it was in the superior part of the major fissure rather than the dependent (lower) portion
  • The plaque was also separate from the visceral-parietal pleural interface
• The authors' conclusion: The authors concluded that, in retrospect, both unique aspects of the case were evident on the plain film, but the CT scan was instrumental in confirming the diagnosis

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Pleural Plaques.

Related studies

• Calcified interlobar pleural plaques: visceral pleural involvement due to asbestos — E.N. Sargent, J.S. Felton, et al. (1981)
• Calcified plaques on mediastinal pleural reflections associated with asbestos dust exposure: four case reports — A. Solomon, G.K. Sluis-Cremer, et al. (1984)
• Subpleural fat pads in patients exposed to asbestos: distinction from non-calcified pleural plaques — E.N. Sargent, W.D. Boswell, et al. (1984)
• CT demonstration of interlobar fissure calcification due to asbestos exposure — S.D. Rockoff (1987)
• Pleural plaques: a signpost of asbestos dust inhalation — E.N. Sargent, G. Jacobson, et al. (1977)
• Multiple pleural plaques. II — H.C. Anton (1968)

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