Focal pleural tumorlike conditions: nodules and masses beyond mesotheliomas and metastasis

Our plain-English summary of Focal pleural tumorlike conditions: nodules and masses beyond mesotheliomas and metastasis, by M.C. de Paula, D.L. Escuissato, L.C. Belém, et al (Respiratory Medicine, 2015).

The study

• Authors: M.C. de Paula, D.L. Escuissato, L.C. Belém, G. Zanetti, A.S. Souza, B. Hochhegger, L.F. Nobre, E. Marchiori
• Journal: Respiratory Medicine
• Published: 2015;109(10):1235-43
• Type of article: Review
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A tumorlike condition of the pleura is any nonmalignant lesion of the pleura or within the pleural space that could be confused with a pleural tumor on initial imaging. Tumorlike conditions of the pleura are relatively rare compared with neoplastic lesions such as mesotheliomas and metastases. Imaging-based diagnosis of these conditions can be difficult due to the similarity of appearance. Thus, recognition of certain imaging patterns and interpretation of these patterns in the clinical context are important. Pleural endometriosis, thoracic splenosis, thoracolithiasis, foreign bodies, pleural pseudotumors and pleural plaques are significant examples of focal tumorlike conditions discussed in this article. Computed tomography is the mainstay imaging technique for the primary assessment of pleural disease, but other imaging methods, such as magnetic resonance imaging and positron-emission tomography, can be of great support in the diagnosis.

Copyright © 2015 Elsevier Ltd. All rights reserved.

In plain English

This article was a review, not an original study. The authors reviewed the clinical, imaging and pathology features of non-cancerous conditions of the pleura (the lining around the lungs) that can look like tumors on scans. The conditions covered were pleural endometriosis, thoracic splenosis, thoracolithiasis, retained surgical sponges (textiloma), pleural plaques and pleural pseudotumor. The article did not describe a search method or collect new data. It was illustrated with scans from individual patients, including a 69-year-old man with asbestos-related pleural plaques. On pleural plaques, the review stated, citing earlier publications, that plaques were the most common manifestation of asbestos-related disease and typically appeared 20 to 30 years after exposure began. It described them as a marker of exposure, usually without symptoms, and benign. It stated that computed tomography (CT) was more sensitive and specific than plain X-ray. It said asbestos fibers, usually chrysotile, were often seen in plaques. The authors concluded that diagnosis relied on recognizing imaging patterns in the clinical context. The authors did not discuss limitations of their own review.

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: Narrative review article (no new data; no search methods described)
• Who was studied: No study population. The review drew on published literature and was illustrated with images from individual patients, including a 69-year-old man with asbestos-related pleural plaques.
• Exposure: Not an exposure study. The pleural plaques section discussed asbestos exposure in general and stated that the asbestos fibers seen in plaques are usually chrysotile.
• Main results:
  • The review stated, citing other sources, that pleural plaques are the most common manifestation of asbestos-related disease, with a latency typically 20 to 30 years after exposure begins.
  • The review stated, citing other sources, that pleural plaques are a marker of exposure, are not usually associated with symptoms or functional impairment, and are benign.
  • The review described plaques as typically found on the parietal pleura, favoring the dome of the diaphragm and the lower back-and-side ribs.
  • The review stated that CT is the preferred method for assessing plaques because it is more sensitive and specific than plain X-ray. It reported that calcification is seen in 10 to 15% of cases on X-ray and 15 to 20% on CT.
  • The review stated that diffuse pleural thickening is seen less often than pleural plaques after asbestos exposure.
• The authors' conclusion: The authors concluded that diagnosing focal tumorlike pleural conditions depends on recognizing certain imaging patterns and interpreting them in the clinical context.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Metastasis, Pleura, Pleural Plaques.

Related studies

• Asbestos-related focal lung masses: manifestations on conventional and high-resolution CT scans — D.A. Lynch, G. Gamsu, et al. (1988)
• Focal dependent pleural thickening at MDCT: pleural lesion or functional abnormality? — M. Claude-Desroches, G. Bierry, et al. (2012)
• Imaging Features of Various Benign and Malignant Tumors and Tumorlike Conditions of the Pleura: A Pictorial Review — J.Y. Bae, Y. Kim, et al. (2020)
• Interlobar pleural plaque mimicking a lung nodule in a patient with asbestos exposure — W.R. Webb, C. Cooper, et al. (1983)
• Malignant mesothelioma with fungating masses and multiple sites involvement — J.K. Sim, J.Y. Oh, et al. (2017)
• Focal pleural thickening mimicking pleural plaques on chest computed tomography: tips and tricks — K.M. Alfudhili, D.A. Lynch, et al. (2016)

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