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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 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

When to consider referral

  • 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

Reference:

  1. Am J Respir Crit Care Med. 2001 Mar;163(3 Pt 1):705-10.
  2. Pulse (2003), 63 (45),96.

 

 

Authors

Dr Alex Burns, RMS GP Sifter

Dr Jonathan Myers, Consultant Respiratory Physician, RCHT