Interlobar pleural plaque mimicking a lung nodule in a patient with asbestos exposure

Our plain-English summary of Interlobar pleural plaque mimicking a lung nodule in a patient with asbestos exposure, by W.R. Webb, C. Cooper, G. Gamsu (Journal of Computer Assisted Tomography, 1983).

The study

• Authors: W.R. Webb, C. Cooper, G. Gamsu
• Journal: Journal of Computer Assisted Tomography
• Published: 1983;7(1):135-6
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001723).

Abstract

Computed tomography (CT) is generally superior to plain chest radiographs in differentiating pleural and pulmonary parenchymal lesions. We report a patient with asbestos exposure who had a rare interlobar pleural plaque involving the major fissure. In this patient CT suggested the presence of a lung nodule but the lateral chest radiograph indicated the correct diagnosis.

In plain English

This was a case report from the Department of Radiology at the University of California, San Francisco. It described one 61-year-old man with asbestos exposure who had chest imaging because of a primary cancer of the tongue. His chest radiographs showed areas of pleural thickening and calcification that the authors called characteristic of asbestos exposure. A side-view (lateral) radiograph showed a localized, plaque-like thickening of the right major fissure, the boundary between lung lobes. Because spread of cancer to the lung could not be ruled out, CT was performed. CT showed multiple pleural plaques on both sides and a nodular density in the right mid lung, which was at first thought to be a lung nodule. Comparing the CT with the lateral radiograph led to the correct diagnosis: a pleural plaque within the fissure. The authors described this as a rare case. They concluded that comparing CT with plain chest radiographs can help define the true nature and location of such an abnormality.

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
• Who was studied: One 61-year-old man with asbestos exposure who was evaluated radiographically because of a primary carcinoma of the tongue. The authors were in the Department of Radiology, University of California, San Francisco. The article does not give the date of the case.
• Exposure: Asbestos exposure. The article does not state the fiber type, job, duration or dose.
• Main results:
  • The patient's chest radiographs showed areas of pleural thickening and calcification characteristic of asbestos exposure.
  • A lateral chest radiograph showed a localized, plaque-like thickening of the upper part of the right major fissure.
  • CT was done because, with the extensive pleural disease, cancer spread to the lung (metastatic pulmonary lesions) could not be excluded.
  • On CT, multiple pleural plaques were seen on both sides, involving the costal, pericardial and diaphragmatic pleural surfaces.
  • CT showed a nodular density in the right mid lung. Because the plane of the major fissure was not easily seen on CT, the thickened part of the fissure was at first misinterpreted as a lung nodule.
  • Comparison with the lateral chest radiograph led to the correct diagnosis of a pleural plaque within the fissure.
  • On closer inspection, the CT scan showed that the lesion lay within the avascular plane that marks the position of the major fissure.
• The authors' conclusion: The authors concluded that, as in their case, comparing CT with plain chest radiographs can help define the true nature and location of such an abnormality. They also stated that unless the fissures are clearly located on CT scans, pleural processes within the fissures may be mistaken for disease of the lung tissue itself.

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: Pleural Plaques, Asbestos Exposure, Chest X-Ray.

Related studies

• Calcified interlobar pleural plaques: visceral pleural involvement due to asbestos — E.N. Sargent, J.S. Felton, et al. (1981)
• Focal pleural thickening mimicking pleural plaques on chest computed tomography: tips and tricks — K.M. Alfudhili, D.A. Lynch, et al. (2016)
• Focal pleural tumorlike conditions: nodules and masses beyond mesotheliomas and metastasis — M.C. de Paula, D.L. Escuissato, et al. (2015)
• CT demonstration of interlobar fissure calcification due to asbestos exposure — S.D. Rockoff (1987)
• Pleural granuloma mimicking malignancy 42 years after slurry talc injection for primary spontaneous pneumothorax — S. Tenconi, L. Luzzi, et al. (2010)
• Visceral pleural thickening in asbestos exposure: the occurrence and implications of thickened interlobar fissures — S.D. Rockoff, E. Kagan, et al. (1987)

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