What Is Pleural Thickening
The pleura is a two-layered membrane which surrounds the lungs and lines the inside of the rib cage. Pleural thickening can be caused by long term exposure to asbestos. Occasionally the asbestos fibres irritate the pleura and may cause fibrosis or scarring to develop there. It can become widespread and can cause the pleura to thicken. This thickening is called diffuse pleural thickening.
Pleural thickening usually affects both lungs and this is known as bilateral pleural thickening, although they are not always affected to the same extent.
There are various morphological types of pleural thickening. Diffuse pleural thickening can occur from malignant and non malignant causes (including asbestos) whereas nearly all of the common causes of nodular pleural thickening are malignant.
Pleural plaques develop in a similar way to pleural thickening but are localised to one area and don't usually interfere with breathing . Please visit our pleural plaques page for more information on this particular asbestos related condition.
What causes pleural thickening?
The disease is often caused by being exposed to asbestos over a period of time. Unlike asbestosis, Pleural thickening can develop after lower levels of exposure to asbestos. Inhaled asbestos fibres settle in the lining of the lungs and can cause scarring, thickening and calcification(Pleural Plaques). Pleural thickening usually develops between 10 and 50 years from exposure to asbestos fibres and sadly there is no known cure.
Other causes of pleural thickening include:
- Types of medication
- Inflammatory disease
- Some types of tumours
- Chronic Pneumonia
- Injuries from an accident
However these usually present in only one lung. Asbestos-related pleural thickening is usually found in both lungs (bilateral) because the asbestos fibres have been breathed into both lungs at the same time.
What Are The Symptoms Of Pleural Thickening?
When the pleura is thickened and scarred it becomes less elastic and constricted, which can cause shortness of breath. Other symptoms include chest pain and tightness, especially after physical exertion. It can be quite debilitating for some sufferers and affect their quality of life.
Pleural thickening can also cause psychological stress; sufferers may live in fear that they could develop a more serious asbestos-related disease.
How is Pleural Thickening Diagnosed?
The diagnosis of pleural thickening is usually made following a chest X-ray in which pleural thickening appears as an irregular shadow of the pleura.
It can also be seen on computed tomography scans, that are used to diagnose asbestosis and pleural plaques. CT scans can detect early signs of pleural thickening when scar tissue is 1 to 2mm in thickness.
Doctors and oncologists may also use positron emission tomography scans and magnetic resonance imaging scans to distinguish between pleural thickening and pleural mesothelioma, a cancer affecting the pleura and often associated with asbestos exposure.
Is There Any Treatment For Pleural Thickening?
Unfortunately, treatment options are limited for pleural thickening as the effects of asbestos on the lung are irreversible.
Treatment is typically limited to supportive care, though more recent case reports have shown pleurectomy surgery to be effective in progressive cases. This is an aggressive treatment involves removing parts of the pleura and surrounding the lungs and usually reserved for mesothelioma patients.
There are a couple of things which may help the sufferer maintain a decent quality of life. Respiratory physiotherapy may be offered, depending on the severity of the condition. According to a 2015 Australian study, pulmonary rehabilitation can significantly improve quality of life for patients with dust-related respiratory diseases, including pleural thickening.
Pulmonary rehabilitation involving moderate intensity exercise can help patients overcome breathing difficulties and stay physically active. Though it is important to start off gently if unused to exercise.
For patients who smoke, quitting is essential after a diagnosis of pleural thickening. Smoking further reduces lung function and increases the risk of developing other respiratory diseases.
Once diagnosed with Pleural Thickening, regular follow ups with a doctor are necessary to check that it doesn't progress to a more serious asbestos related condition.
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