Imaging the pleura

Our plain-English summary of Imaging the pleura, by C. Mortensen, R. Bhatnagar, A.J. Edey (British Journal of Hospital Medicine, 2012).

The study

• Authors: C. Mortensen, R. Bhatnagar, A.J. Edey
• Journal: British Journal of Hospital Medicine
• Published: 2012;73(11):626-32
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pleural disease is now recognized as an important subspecialty of pulmonary medicine, with increasing provision being made for specialist services and procedures. In response, the field of pleural imaging has advanced in recent years, especially with regard to ultrasound. Salient multimodality imaging techniques are discussed.

In plain English

This article was a narrative review, not a new study. The authors described how pleural conditions seen in hospital medicine appear on chest X-ray, computed tomography (CT), ultrasound, magnetic resonance imaging and positron emission tomography. Its numbers come from earlier studies the authors cited. They described pleural plaques as pathognomic (a telltale sign) of previous asbestos exposure, typically taking 20 to 30 years before becoming visible on chest X-ray. They cited a 1991 study in which CT was more sensitive than chest X-ray for plaque (95% vs 58%). They noted that asbestos may also be implicated in diffuse pleural thickening. Because its appearance is non-specific, other markers such as calcified plaques and a clear exposure history are needed. Citing a 1997 paper, they wrote that malignant pleural mesothelioma is strongly associated with asbestos, with a typical latency of around 30 to 40 years, and occurs in a minority (between 5 and 7%) of at-risk individuals. They described CT as the most widely used tool for diagnosing it. The authors concluded that plaques or proven benign thickening often need little follow-up beyond plain radiography.

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 of imaging methods for pleural disease. No new data were collected.
• Who was studied: No study population. The review covers pleural conditions commonly encountered in hospital medicine. The authors were based at Southmead Hospital, Bristol, UK.
• Exposure: Asbestos exposure is discussed as a cause of pleural plaques, diffuse pleural thickening and malignant pleural mesothelioma. No fiber types are named. The review also covers non-asbestos causes of pleural disease.
• Main results:
  • Pleural plaques: the authors stated a typical latency of 20 to 30 years before progressive calcification makes plaques visible on plain chest X-ray.
  • Citing al Jarad et al (1991), the authors stated that CT is much more sensitive than chest X-ray for plaque (95% vs 58%).
  • Asbestos may also be implicated in diffuse pleural thickening. Because appearances are often non-specific, the authors wrote that other radiological markers of asbestos exposure, such as calcified plaques, and a clear history of exposure are needed to confirm the diagnosis.
  • The authors listed the International Labour Office (2011) criteria for diffuse pleural thickening in the context of asbestos exposure: obliteration of the costophrenic angle; bilateral thickening involving at least 25% of the chest, or 50% if unilateral; and pleural thickness greater than 5 mm at any site.
  • Citing Ferretti et al (1997), the authors stated that malignant pleural mesothelioma is strongly associated with asbestos, with a typical latency of around 30 to 40 years after exposure.
  • Citing the same source, the authors stated that malignant pleural mesothelioma occurs in a minority of at-risk individuals, between 5 and 7%.
  • The authors stated that CT is the most widely used modality for diagnosing malignant pleural mesothelioma.
  • Citing Leung et al (1990), the authors listed four CT features indicating a malignant rather than benign process: circumferential pleural thickening, nodular pleural thickening, parietal pleural thickening greater than 1 cm, and mediastinal pleural involvement.
  • Biopsy: blind Abrams needle biopsies had a diagnostic rate of only 57% for malignancy (Tomlinson, 1987). Contrast-enhanced CT-guided targeted biopsy was reported as 86 to 88% sensitive and 100% specific (Adams and Gleeson, 2001; Maskell et al, 2003).
• The authors' conclusion: The authors concluded that plain radiography is usually indicated first, and that conditions such as pleural plaque or proven benign thickening often require little further follow-up. They concluded that contrast-enhanced CT is now the mode of choice for pleural disease suspicious for malignancy and for image-guided biopsy. They saw MRI and positron emission tomography as having a limited role.

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: Pleura, Ultrasound.

Related studies

• Imaging of the pleura — E.J. Helm, T.N. Matin, et al. (2010)
• Length-dependent retention of carbon nanotubes in the pleural space of mice initiates sustained inflammation and progressive fibrosis on the parietal pleura — F.A. Murphy, C.A. Poland, et al. (2011)
• Imaging of the pleura — N.L. Müller (1993)
• Sonography of the pleura — J. Reuss (2010)
• Subarachnoid-pleural fistula as a complication of malignant pleural mesothelioma — C.M. Heyer, A. Theile, et al. (2006)
• Diffuse pleural thickening following heart failure-related pleural effusions in an asbestos exposed patient — M. Evison, P. Barber (2015)

Browse more research in British Journal of Hospital Medicine, or return to medical research.