Imaging of the pleura

Our plain-English summary of Imaging of the pleura, by N.L. Müller (Radiology, 1993).

The study

• Author: N.L. Müller
• Journal: Radiology
• Published: 1993;186(2):297-309
• Type of article: Review
• Cited by: 148 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This review summarized the main pleural diseases, described their imaging appearances, and assessed the role of chest radiography, ultrasound, conventional and high-resolution computed tomography (CT), and magnetic resonance (MR) imaging in diagnosis and management. It divided pleural abnormalities into pleural effusion, empyema, focal pleural disease and diffuse pleural disease. The author stated that chest radiography remained the first examination and that MR imaging played a very limited role. For empyema, the reported success rate was 35%-71% with conventional chest tubes and 70%-90% with image-guided catheter drainage, which was recommended as the primary treatment. Pleural plaques were described as the most common manifestation of asbestos exposure. They were seen radiologically in 20%-60% of workers exposed to high concentrations of asbestos, with a latency of about 15 years. Using International Labour Office criteria, the sensitivity of radiography for plaques ranged from 30% to 80% and the specificity from 60% to 80%. High-resolution CT was the most accurate technique but was not recommended for screening because of its cost. About 80% of malignant mesotheliomas occurred in people exposed to asbestos. In a cited series of 74 patients, circumferential pleural thickening, nodular pleural thickening, parietal pleural thickening of more than 1 cm, and mediastinal pleural involvement had specificities of 88%-100% for malignant disease. The author stated that CT could play a major role in distinguishing malignant from benign diffuse pleural disease and in guiding biopsy.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a review by a radiologist at the University of British Columbia and Vancouver General Hospital. It summarized published research on imaging of pleural disease: fluid around the lung, empyema (infection), focal disease such as pleural plaques and localized tumors, and diffuse disease including malignant mesothelioma. It described how chest radiography, CT, high-resolution CT, ultrasound and MR imaging are used. Citing other studies, it reported that pleural plaques were seen on radiographs in 20%-60% of workers exposed to high concentrations of asbestos. Asbestos-related diffuse pleural thickening was much less common than plaques. About 80% of malignant mesotheliomas occurred in people exposed to asbestos. In a cited CT study (Leung et al) of diffuse pleural disease, certain CT signs correctly identified 28 of 39 malignant cases. Calcification was seen in 16 of 35 benign cases and 3 of 39 malignant cases. The article did not name specific asbestos fiber types. The author wrote that chest radiography remains the first examination and that MR currently plays a very limited role.

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 (State-of-the-Art review) of the imaging literature on pleural disease
• Who was studied: No study population of its own; the review covered published studies of patients with pleural effusion, empyema, focal pleural disease (including asbestos-related pleural plaques) and diffuse pleural disease (including malignant mesothelioma)
• Exposure: Asbestos exposure, with no fiber types specified, discussed as a cause of pleural plaques, diffuse pleural thickening and malignant mesothelioma; imaging methods (chest radiography, CT, high-resolution CT, ultrasound, MR) were the main subject
• Main results:
  • Citing other studies, pleural plaques were seen radiologically in 20%-60% of workers exposed to high concentrations of asbestos
  • Citing other studies, using International Labour Office criteria, the sensitivity of chest radiography for detecting pleural plaques ranged from 30% to 80% and the specificity from 60% to 80%
  • Good-quality chest radiographs read by an expert reader were described as having high sensitivity for pleural plaques
  • Citing a literature review by Jones et al, the reduction in lung function due to pleural plaques was described as small; plaques themselves were described as asymptomatic
  • Asbestos-related diffuse pleural thickening was much less common than pleural plaques
  • Citing other sources, approximately 80% of malignant mesotheliomas occurred in individuals exposed to asbestos
  • Citing other sources, the lifetime risk of mesothelioma in asbestos workers was given as 10%, with an average latency of 35 years
  • In a cited CT series of 50 mesothelioma patients, pleural thickening was seen in 92% of cases before treatment
  • In a cited CT study by Leung et al of patients with diffuse pleural disease, the presence of one or more CT criteria correctly identified 28 of 39 malignant cases (sensitivity 72%, specificity 83%)
  • In the same cited series, pleural calcification was seen in 16 of 35 patients with benign pleural thickening and 3 of 39 patients with malignant pleural disease
• The authors' conclusion: The author stated that chest radiography remains the first examination in assessing pleural disease, with conventional CT, high-resolution CT or ultrasound used for further evaluation depending on the clinical situation, and that MR imaging currently plays a very limited role

Topics

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

Medical terms in this study, explained in our Lexicon: Pleura, Ultrasound, Pleural Effusion, Empyema, Pleural Plaques, Asbestos Exposure, Latency, High-Resolution CT (HRCT).

Related studies

• Imaging of the pleura — E.J. Helm, T.N. Matin, et al. (2010)
• Imaging the pleura — C. Mortensen, R. Bhatnagar, et al. (2012)
• Asbestos: when the dust settles an imaging review of asbestos-related disease — H.D. Roach, G.J. Davies, et al. (2002)
• Asbestos-related pleural disease: value of dedicated magnetic resonance imaging techniques — M.A. Weber, M. Bock, et al. (2004)
• Asbestos-related diseases of lung and pleura: clinical picture and illustrative cases — B. Varkey, U.N. Kumar (1978)
• CT and MR in pleural disease — T.C. McLoud (1998)

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