Pleural plaques
These are circumscribed areas of hyaline fibrous tissue on the surface of pleura, and are often found as an incidental finding on chest Xray.
In general, the finding of calcified/non-calcified pleural plaques on a chest X-ray in a patient with a history of asbestos exposure does not require formal follow-up and the patient can be reassured1
They are more common in individuals exposed to fibrous materials such as asbestos, but there is evidence that shows no relation between the extent of plaque and cumulative asbestos exposure, smoking history or time since exposure1. Neither the presence nor the extent of the plaques is correlated with lung function parameters. The risk of mesothelioma in a patient relates to the history of asbestos exposure and not to the presence of pleural plaques per se.
The presence of pleural plaques per se does not qualify for prescribed disease status or for industrial injuries benefit2
For further information please see: http://library.nhsggc.org.uk/mediaAssets/Respiratory%20Medicine/BTS%20Plueral_Plaques299912_acc.pdf
When to consider referral for pleural plaques: (both calcified and non-calcified)
- If associated with other CXR changes such as interstitial lung disease
- If falls into the referral criteria for suspected cancer
- If falls into the referral criteria for other respiratory illness
Primary care investigations/management prior to referral:
- Pleural plaques do not have further disease potential and, therefore, do not need to be followed up radiologically.
Clinic options available
- Routine respiratory clinics
Red Flags
- Persistent haemoptysis in smoker/ex-smoker age >40 years
- CXR suggestive of malignancy
References:
- Am J Respir Crit Care Med. 2001 Mar;163(3 Pt 1):705-10.
- Pulse (2003), 63 (45),96.
Date reviewed June 24
Next review due June 26
Authors Dr Alex Burns & Dr Madeleine Attridge RMS GP Sifters
Contributor Dr Jonathan Myers, Consultant Respiratory Physician, RCHT