Uncategorized

• What is it:
  • Pleural calcification refers to:
    • The deposition of calcium salts within the pleura,
    • typically resulting from chronic inflammation, prior injury, or exposure to certain agents.
  • It is often associated with:
    • Bilateral calcifications: Seen in systemic or environmental exposures like asbestos.
    • Unilateral calcifications: Associated with localized conditions like hemothorax or prior infection.
• Etymology:
  • Derived from the Latin word calx, meaning “lime,” reflecting the calcium content in these deposits.
• AKA:
  • Calcified pleural plaques, Pleural calcinosis.
• How does it appear on each relevant imaging modality:
  • Chest X-ray:
    • Bilateral calcifications:
      • Dense, irregular opacities along the pleura, commonly affecting:
        • Lateral chest walls,
        • Diaphragmatic pleura.
    • Unilateral calcifications:
      • May be focal or extensive, typically in the setting of:
        • Hemothorax,
        • Tuberculosis, or
        • Empyema.
  • Chest CT:
    • Parts:
      • Well-defined areas of calcification within the parietal pleura, often sparing the visceral pleura.
    • Size:
      • Varies from small focal plaques to extensive calcifications involving large portions of the pleura.
    • Shape:
      • Flat or irregular; may follow the contour of the chest wall or diaphragm.
    • Position:
      • Bilateral:
        • Associated with asbestos exposure or diffuse processes.
      • Unilateral:
        • Commonly seen in post-traumatic or post-infectious cases.
    • Character:
      • High-attenuation plaques with or without associated pleural thickening.
    • Time:
      • Chronic and develops over years following exposure or injury.
  • Ultrasound:
    • May show hyperechoic plaques with posterior acoustic shadowing.
  • MRI:
    • Rarely used but may demonstrate low signal intensity corresponding to calcified areas.
• These findings reflect:
  • Exposure-related processes:
    • Bilateral:
      • Asbestos exposure (most common).
      • Talc pleurodesis.
    • Unilateral:
      • Talc pleurodesis (site-specific).
  • Post-inflammatory processes:
    • Tuberculosis-related pleuritis.
    • Chronic empyema.
  • Post-traumatic processes:
    • Hemothorax with fibrotic healing and calcification.
• Differential diagnosis:
  • Benign causes:
    • Bilateral:
      • Asbestos-related pleural plaques.
      • Talc pleurodesis (iatrogenic).
    • Unilateral:
      • Post-infectious calcifications (e.g., tuberculosis, empyema).
      • Post-hemothorax fibrosis and calcification.
  • Malignant causes:
    • Mesothelioma (rarely associated with calcifications but can occur).
    • Secondary calcification in malignant pleural metastases.
• Recommendations:
  • Correlate imaging findings with clinical history, including:
    • Occupational exposure (e.g., asbestos),
    • Prior infections (e.g., tuberculosis), or
    • History of hemothorax or pleurodesis.
  • Perform Chest CT to assess the extent and distribution of calcifications, noting whether bilateral or unilateral.
  • Monitor for progression or associated findings suggestive of malignancy (e.g., pleural masses or effusion).
  • Consider biopsy only if calcification is associated with suspicious findings such as nodular thickening or mass lesions.
• Key points and pearls:
  • Asbestos exposure is the most common cause of bilateral pleural calcifications, particularly in industrial workers.
  • Unilateral calcifications are more frequently associated with trauma, infection, or iatrogenic conditions (e.g., talc pleurodesis).
  • Calcified pleural plaques are typically benign and asymptomatic, serving as markers of prior exposure or injury.
  • Associated pleural thickening or masses warrant further evaluation for malignancy.
  • Talc pleurodesis can produce calcifications and should be considered in post-treatment imaging interpretations.