Chest X-ray - Pulmonary disease

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Calcified plaques are associated with previous exposure to asbestos and are almost invariably asymptomatic
They appear as irregularly-shaped areas of calcific density (as white as bone) and should not be mistaken for areas of consolidation
Pleural plaques are a benign entity (do not lead to cancer or mesothelioma) and their presence does NOT equate to the diagnosis of ‘asbestosis’
Note: Asbestosis is fibrosis of the lung caused by the presence of asbestos fibres in the lungs themselves – it may have similar appearances to the fibrosis seen on the previous page

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Pleural plaques may have a well-defined edge
Some plaques may be very large
The plaques form in the parietal pleura, including that of the mediastinum (arrowheads) and diaphragm (asterisk)

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When seen en face they may be difficult to see – as is the left upper zone plaque in this image
The diaphragm is often the best place to look for plaques where they lie in the plane of the X-ray beam

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Mesothelioma frequently presents as a pleural effusion – often a lot smaller than the effusion in this image

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(Same patient as image above)
The effusion in the image above was drained
Lobulated thickening of the pleura became visible
The left lung is reduced in volume
These are the typical features of mesothelioma
Note: Pleural metastases (usually from an adenocarcinoma) may have similar appearances to mesothelioma

Page author: Dr Graham Lloyd-Jones BA MBBS MRCP FRCR - Consultant Radiologist - Salisbury NHS Foundation Trust UK (Read bio)

Last reviewed: October 2019

Chest X-ray - Pulmonary disease - Pleural disease