16th January 2024

Pleural disease

Sequelae of asbestos exposure include pleural effusions, pleural plaques, and pleural thickening. These may occur independently or concomitantly. 

Pleural effusions features:

• Duration of time between exposure to onset of effusion is reported as 15 to 46 years
• Usually small and unilateral 
• Pleural fluid is exudative and can be blood-stained
• Other sinister causes such as Mesothelioma and lung malignancy, are to be investigated first; therefore, may require thoracoscopy +/- pleural biopsy
• Prognosis– normally self-resolving, and approximately one-third recur

Pleural plaques (PP) features:

• Benign finding on the parietal pleura 
• Most common manifestation of asbestos exposure
• They appear approximately twenty years after asbestos exposure
• Usually, asymptomatic and incidental findings

Pleural thickening features:

• Visceral pleural thickening secondary to asbestos exposure
• Adhesion of visceral and parietal pleura leading to diffuse pleural thickening (DPT)
• Extensive DPT can lead to restrictive lung disease and symptoms of dyspnoea and chest pain

Mesothelioma:

• Malignant disease of the pleura
• Asbestos exposure accounts for 85% of cases of Mesothelioma in the UK
• Latency period of over 30 years from exposure to presentation
• Chest pain and dyspnoea are the most common presenting symptoms as a result of pleural effusion
• Most common x-ray findings include pleural effusion and pleural thickening
• Prognosis is poor, with an average life expectancy between one to two years from diagnosis