The pleura in health and disease

Our plain-English summary of The pleura in health and disease, by R. Murali, K. Park, K.O. Leslie (Seminars in Respiratory and Critical Care Medicine, 2010).

The study

• Authors: R. Murali, K. Park, K.O. Leslie
• Journal: Seminars in Respiratory and Critical Care Medicine
• Published: 2010;31(6):649-73
• Type of article: Review
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A wide variety of local, regional, and systemic diseases may have pleural manifestations. The scope of this pathology encompasses a wide spectrum ranging from minimal inflammatory changes to highly malignant neoplasms. An overview of the normal structure of the pleura is provided, along with the diseases that may be encountered. Pleural specimens from patients with pneumothorax are rarely encountered by pathologists. In contrast, pathologists frequently receive pleural specimens showing evidence of inflammation, repair, or neoplasm. In these circumstances, an awareness of less common (and often clinically highly important) conditions such as epithelioid hemangioendothelioma and primary pleural malignant mesothelioma is essential. Knowledge of the clinical setting (e.g., disease tempo) and radiological picture (e.g., laterality) is often of great value to the pathologist in arriving at a correct diagnosis. Similarly, knowledge of the normal anatomical considerations and familiarity with the expected pleural histopathology for the most clinically relevant pleural diseases are critical assets for pulmonary physicians in providing optimal care for their patients.

© Thieme Medical Publishers.

In plain English

This article was a narrative review, not a study with its own patients or data. The authors described the normal structure of the pleura (the lining around the lungs) and the range of diseases that affect it, from the viewpoint of diagnosis under the microscope. It covered pneumothorax, infections, inflammatory conditions, pleural fibrosis, tumors and rare lesions. On asbestos, the review stated that pleural plaques are almost invariably associated with asbestos exposure but bear no relation to the presence of pulmonary asbestosis. It stated that rounded atelectasis is usually associated with asbestos exposure, and that localized fibrous tumor has no association with it. It described the tumor-causing role of amphiboles such as crocidolite and amosite as clearly demonstrated. It described the role of other asbestos fibers in causing mesothelioma as less well established. It noted that the delay before mesothelioma appears is often 30 years or longer. The authors wrote that diagnosing mesothelioma can be extremely difficult, and that clinical and radiological information helps pathologists reach a correct diagnosis. The review did not address legal questions and was not all-inclusive.

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 pleural anatomy and pleural diseases from a pathology (tissue diagnosis) perspective; no original data
• Who was studied: Not applicable: a review with no study population of its own
• Exposure: Asbestos was one of many causes of pleural disease discussed. The review listed six naturally occurring asbestos forms: chrysotile (serpentine) and the amphiboles crocidolite, amosite, tremolite, anthophyllite and actinolite. It also listed non-mining sources of exposure.
• Main results:
  • The review stated that pleural plaques are almost invariably associated with asbestos exposure
  • The review stated that pleural plaques bear no relation to the presence of pulmonary asbestosis
  • The review described the tumor-causing role of amphiboles such as crocidolite and amosite as clearly demonstrated, and the role of other asbestos particles in causing mesothelioma as less well established
  • The review stated that the latency before mesothelioma becomes clinically apparent may be very long, often 30 years or longer
  • The review stated that rounded atelectasis is usually associated with asbestos exposure
  • The review stated that localized (solitary) fibrous tumor of the pleura has no association with asbestos exposure
  • The review stated that the pathological diagnosis of mesothelioma can be extremely difficult
• The authors' conclusion: The authors concluded that knowing the clinical setting and the radiological picture is often of great value to the pathologist in reaching a correct diagnosis of pleural disease
• Limitations the authors state:
  • The authors stated that space constraints prevented an all-inclusive discussion of pleural pathology
  • The authors stated that the legal implications of mesothelioma from occupational asbestos exposure were outside the scope of the article

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, Pathology, Neoplasm, Pneumothorax, Inflammation, Epithelioid, Malignant Mesothelioma, Histopathology.

Related studies

• 'Black Spots' and hyaline pleural plaques on the parietal pleura of 150 urban necropsy cases — K. Mitchev, P. Dumortier, et al. (2002)
• Imaging of the pleura — E.J. Helm, T.N. Matin, et al. (2010)
• Histopathology of the pleura — B. Corrin, B.J. Addis (1990)
• Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases — M. Metintas, I. Ucgun, et al. (2002)
• Physician-based ultrasound-guided biopsy for diagnosing pleural disease — R.J. Hallifax, J.P. Corcoran, et al. (2014)
• Pleuropulmonary fibrosis after long-term treatment with the dopamine agonist pergolide for Parkinson Disease — R. Tintner, P. Manian, et al. (2005)

Browse more research in Seminars in Respiratory and Critical Care Medicine, or return to medical research.