Pleural Plaques - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Pleural plaques are a benign condition in which there is excess deposition of tissue in the lungs. Pleural plaques, calcified pleural plaques, or pleural plaque asbestos are potential risk factors for asbestos-related lung cancer. Workers exposed to asbestos for a longer period are prone to the accumulation of pleural plaques (pleural plaque asbestos or calcified pleural plaques). It is commonly seen in the chest lining and the lungs' outer membrane.

This condition is also known as hyaline pleural plaques because it involves the hyaline tissue present in the lungs. The non-cancerous growth occurs due to the inability of the lungs to expel the asbestos fibers. These fibers also affect other organs but create a great impact only in the lungs. The most commonly affected gender due to pleural plaques is men. It affects both the lungs. The lesions are present in the form of nodules in some patients.

What Are the Various Causes Associated With the Formation of Pleural Plaques?

The workers involved in the following occupations are affected by pleural plaques;

• Construction Sites - The workers using the asbestos sheets as rooftops are prone to pleural plaques.

• Factory - The prolonged exposure to the chemicals during fireworks manufacturing causes pleural plaques.

• Industrial Work - The workers are exposed to heat and chemicals during steel production.

• Textile Work - The workers involved in textile work like cotton, jute, and wool inhale very fine particles. These particles lead to the thickening of the pleural tissue.

• Miners - The laborers in the mines are constantly exposed to metals at high temperatures. It affects the thin lining of the lungs.

• Baby Products - A recent study found that talc powder contains fibers of asbestos, which are very harmful.

• Ship Yards - The crew working in ship buildings is exposed to various chemicals.

What Are the Symptoms of Pleural Plaques?

The patients affected by pleural plaques remain asymptomatic for a long time. The mild symptoms associated with them are as follows;

• Cough - Asbestos fibers are minute particles and can reach the lungs through inhalation. It irritates the lining of the windpipe. These fibers aggravate the symptoms and eventually result in persistent cough.

• Hemoptysis - The cells present in the pleural layer become inflamed and damage the upper respiratory tract. It produces blood streaks while vomiting.

• Chest Pain - The immune system tries to fight against asbestos fibers. The inflamed tissue tries to heal by producing collagen. The accumulation of these collagen fibers makes the lung rigid and causes chest pain.

• Breathing Difficulty and Breathlessness- In patients with breathing difficulty, there is a decreased breathing ability due to the increased deposition of collagen fibers, leading to bi-apical pleural thickening. The scarring on the pleura hardens over time and interferes with breathing. The patient with pleural plaques or pleural plaque asbestos experiences breathlessness and shortness of breath due to a decrease in total lung capacity, affecting measures of lung also. People affected by other respiratory disorders are more likely to get them.

What Are the Diagnostic Methods for Pleural Plaques?

The pleural plaques are often diagnosed when the patient does diagnostic tests for other systemic examinations.

The following methods are used to diagnose them in the lungs:

• Chest X-rays - Pleural plaques can be observed with noninvasive techniques like chest X-rays. They appear obvious in the radiographic image. These deposits are seen as translucent residues in the lungs. These plaques are more commonly found in the lining than the lobes. The presence of a calcified mass identifies them. The thickened edges give a folded appearance to the chest X-ray.

• Computed Tomography (CT) Scan - The non-calcified pleural plaques can be observed using computed tomography. Their size, anywhere in the chest or lungs, can be identified using a computed tomography scan. It provides an accurate image of the lobes to detect the abnormalities present in the parenchymal tissues of the lungs. The thin fiber extends like hair from the plaque in severe cases. It can be examined using computed tomography. The enlargement of lymph nodes due to pleural plaques can also be evaluated using computed tomography. It is used to analyze the severity of pleural plaque conditions.

• Biopsy - The lung biopsy is used to determine whether the condition is pleural plaque or lung cancer. A small piece is collected from the thickened lung tissue. It is observed under the microscope for the presence of malignant cells. The tool is inserted into the lungs to remove tissue under the guidance of computed tomography.

What Are the Differential Diagnosis of Pleural Plaques?

Differential diagnosis on a computed tomography (CT) scan:

• Pleural tuberculosis - Granulomatous disease.

• Status post talc pleurodesis.

  • Plaques related to asbestos can be seen if they are on a diaphragmatic dome and bilateral.

Differential diagnosis on plain film:

• Extrapleural fat.

• Diffuse pleural thickening.

• Pleural pseudo plaques - Plaque-like pulmonary or lung opacity

• Pleural tumors:

  • Mesothelioma - A tumor of the tissues lining the heart, stomach, lungs, and other organs.

  • Pleural metastasis - The cancer that spreads to the pleura or thin membrane of the lungs but originates from some other organ.

  • Localized mediastinal malignant mesothelioma.

• Rib fracture.

What Are the Treatment Procedures for Pleural Plaques?

There is no particular treatment for pleural plaques. However, mesothelioma is treated by the following methods;

• Pneumonectomy - The lungs affected by excess deposition of collagen fibers are removed by a surgical procedure called a pneumonectomy. An incision is made to remove the lung, and a thoracoscope is inserted using a camera. The surgeon performs the pneumonectomy under the guidance of a video. This procedure is favorable for patients at an early stage of tumors that are adjacent to the outer lining of the lungs.

• Pleurectomy - The affected pleural tissue is removed using the pleurectomy surgical technique. The damaged layers of the pleura are removed. The scar tissue and fibrous layers are removed using pleurectomy. It has a minimal success rate. However, there is an improvement in the breathing process.

Conclusion

Passive asbestos exposure occurs among the family members of the workers. It spreads through contact with exposed clothes. The progress of the pleural plaques is very slow; it takes decades to affect the lungs. So, the individual can be saved from it if the symptoms are treated earlier. Avoid smoking, as it can aggravate the pleural plaques or pleural plaque asbestos. If the worker cannot quit the occupation, he should use personal protective equipment to protect himself. It is better to cover the entire body with disposable clothes during work and discard them after working hours. This prevents the transmission of asbestos fibers. Patients with pleural plaques and living in an area with a highly polluted atmosphere should stay indoors. Consult a medical professional if there are any symptoms of pleural plaque. People with occupational hazards should get a routine health checkup. Also, the employer should conduct screening camps to detect the pleural plaques.