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Pleural plaques are patchy collections of hyalinized collagen in the parietal pleura. [2] They have a holly leaf appearance on X-ray. [1] They are indicators of asbestos exposure, and the most common asbestos-induced lesion. [3] They usually appear after 20 years or more of exposure and never degenerate into mesothelioma.
Asbestosis resembles many other diffuse interstitial lung diseases, including other pneumoconiosis. The differential diagnosis includes idiopathic pulmonary fibrosis (IPF), hypersensitivity pneumonitis, sarcoidosis, and others. The presence of pleural plaques may provide supportive evidence of causation by asbestos.
Asbestos-related diseases are disorders of the lung and pleura caused by the inhalation of asbestos fibres. Asbestos-related diseases include non-malignant disorders such as asbestosis (pulmonary fibrosis due to asbestos), diffuse pleural thickening, pleural plaques, pleural effusion, rounded atelectasis and malignancies such as lung cancer and malignant mesothelioma.
Figure A shows the location of the lungs, airways, pleura, and diaphragm in the body. Figure B shows lungs with asbestos-related diseases, including pleural plaque, lung cancer, asbestosis, plaque on the diaphragm, and mesothelioma. Left-sided mesothelioma (seen on the right of the picture): chest CT
The holly leaf sign is a radiologic sign observed on chest radiographs that has been used to describe the appearance of pleural plaques typically resulting from asbestos exposure. The irregular margins of a calcified pleural plaque are known to resemble the spikey edges of a holly leaf. [1]
Numerous epidemiological studies have associated occupational exposure to asbestos with the development of pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumors, and diffuse malignant mesothelioma of the pleura and peritoneum.
Workers are frequently exposed to asbestos during demolition and renovation work, which can cause asbestosis and/or mesothelioma. Asbestos exposure can also cause pleural effusion, diffuse pleural fibrosis, pleural plaques, and non-mesothelioma lung cancer. Smoking greatly increases the lung cancer risk of asbestos exposure. [3]
Pleural plaques (indicating asbestosis) Dilated esophagus (indicating connective tissue disease) Distal clavicular erosions (indicating rheumatoid arthritis) Extensive lymph node enlargement; Pleural effusion; Pleural thickening (indicating connective tissue disease/drugs)
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