Extensive Bilateral Pleural Plaques: A Cadaveric Case Study

Our plain-English summary of Extensive Bilateral Pleural Plaques: A Cadaveric Case Study, by M. Rajaram-Gilkes, R. Frank (Curēus, 2026).

The study

• Authors: M. Rajaram-Gilkes, R. Frank
• Journal: Curēus
• Published: 2026;18(4):e107079
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Pleural plaques are the most common manifestation of asbestos-related pleural disease and function primarily as markers of prior exposure rather than as direct causes of clinically significant symptoms, often appearing several decades after initial contact. They are typically asymptomatic and discovered incidentally on imaging studies or at autopsy, and they initially present as small, well-circumscribed lesions along the parietal pleura, most commonly over the rib surfaces while sparing the intercostal spaces. They may progressively enlarge, coalesce, and undergo calcification over time. Although asbestos exposure is the primary etiology, pleural plaques and pleural calcifications may also arise from prior infections such as tuberculosis or empyema, trauma, hemothorax, end-stage renal disease, or chronic inflammatory and autoimmune conditions such as systemic lupus erythematosus and rheumatoid arthritis, and in some instances they may be idiopathic. Additionally, pleural plaques can be associated with mesothelioma. When extensive, pleural plaques may restrict lung expansion, leading to exertional dyspnea that can progress to dyspnea at rest and, in advanced cases, respiratory insufficiency. During routine cadaveric dissections conducted as part of the preclinical medical curriculum at the Geisinger Commonwealth School of Medicine (GCSOM), Scranton, Pennsylvania, extensive bilateral pleural thickening, predominantly involving the diaphragmatic pleura, was observed in an 89-year-old male cadaver. After the opening of the thoracic cage and removal of the lungs and heart, pleural plaques were identified, examined, and measured. The pleural cavities were relatively free, with minimal adhesions involving the bases of both lungs in the diaphragmatic regions, and any evidence of pleural effusion was likely lost during the dissection process. Small, isolated pleural plaques were also noted along the anterior aspect of the right parietal costal pleura. A small, firm mass was palpated within the anterior border of the right upper lobe. Tissue specimens were obtained from the pleural plaques of the anterior chest wall and diaphragmatic pleura, as well as from the pulmonary mass, for histopathological evaluation. Microscopic examination demonstrated abundant fibrocollagenous thickening of the parietal pleura with adjacent fibro-adipose connective tissue and associated inflammation, without evidence of asbestos fibers. Histological analysis of the pulmonary mass was consistent with acute pneumonia. Pleural plaques are frequently encountered as incidental findings on chest radiographs and computed tomography scans in elderly individuals, particularly those with prior asbestos exposure, yet many such findings remain clinically uninvestigated during life. Establishing an etiology in cadaveric cases poses a significant challenge due to the absence of reliable occupational, environmental, and medical histories. While the histopathologic features observed in this case are consistent with previously published descriptions, the gross anatomical documentation of extensive pleural plaques predominantly confined to the diaphragmatic pleura, including detailed measurements, texture, and imaging, has not been previously reported. Dissemination of these findings aims to enrich anatomical and pathological educational resources, support future research, and deepen the understanding of pleural pathology encountered during cadaveric dissection and medical education.

Copyright © 2026, Rajaram-Gilkes et al.

In plain English

This case report described one 89-year-old male body donor dissected during preclinical medical education at Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania. He had worked for many years as a steam fitter in Union, New Jersey, and died of a glioblastoma. Whitish plaques involved the diaphragmatic pleura on the left and right, while the abdominal side of the diaphragm showed no plaques. The left plaque measured 12.9 x 6.5 cm and the right 13.5 x 10 cm, each 0.8 cm thick. Four smaller plaques lay on the right front chest wall; the largest measured 3.5 x 2.5 cm and was about 0.3 cm thick. Under the microscope, the plaques consisted of dense fibrous collagen with few cells. A firm 2.4 x 2.2 x 3.9 cm lump in the right upper lung was consistent with acute pneumonia. The authors reported no evidence of asbestos crystals in the lung tissue. They wrote that, given his occupation, the plaques most likely resembled those caused by asbestos exposure. They added that there was no definitive way to establish the cause beyond his occupation, and that information on prior infections and other relevant diseases was unavailable.

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 of a single cadaver examined during anatomy dissection, with microscopic (histopathological) examination of tissue samples
• Who was studied: One 89-year-old male body donor dissected during preclinical medical education at Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA. He had worked for many years as a steam fitter in Union, New Jersey.
• Exposure: No asbestos exposure was measured or documented. The only exposure information was the donor's long-term occupation as a steam fitter. No fiber type was identified.
• Main results:
  • Left diaphragmatic pleural plaque, next to the tendinous portion of the diaphragm: 12.9 x 6.5 cm, 0.8 cm thick
  • Right diaphragmatic pleural plaque, next to the tendinous portion of the diaphragm: 13.5 x 10 cm, 0.8 cm thick
  • Four small, isolated plaques were found on the parietal pleura of the anterior chest wall. The largest (labeled p) measured 3.5 x 2.5 cm and was about 0.3 cm thick.
  • Viewed from the abdominal side, the diaphragm showed no plaques.
  • Under the microscope (hematoxylin and eosin stain), the diaphragmatic plaque showed dense fibrosis with thick collagen and few fibroblasts. The authors described the collagen as having a basket-weave pattern.
  • A firm nodule measuring 2.4 x 2.2 x 3.9 cm in the right upper lobe showed a severe neutrophilic infiltrate suggesting acute pneumonia.
  • The authors reported no evidence of asbestos crystals in the lung tissue.
• The authors' conclusion: The authors concluded that, based on the donor's occupation and the known causes and appearance of such plaques, the plaques most likely resembled those caused by asbestos exposure. They also stated that determining the cause of extensive bilateral plaques is particularly challenging without evidence of asbestosis or mesothelioma.
• Limitations the authors state:
  • The donor died of a glioblastoma of about one month's duration. There was no definitive way to establish the cause of the plaques beyond his work as a steam fitter.
  • No information was available on prior infections or on treatment for conditions such as tuberculosis, rheumatoid arthritis, lupus (SLE) or malignant disease, all of which can also cause pleural plaques.

Topics

Medical terms in this study, explained in our Lexicon: Bilateral, Pleural Plaques, Asbestos-Related Pleural Disease, Autopsy, Parietal Pleura, Asbestos Exposure, Etiology, Pleural Calcification.

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