Pleural Calcification

The pattern of pleural calcification and the patient's history are helpful in determining the usually remote cause of the calcification. Here, Drs Mahesh Duggal, Achal Dhupa, Krishna Badhey, and Arunabh of North Shore University Hospital of Forest Hills, NY, offer 2 cases that illustrate the importance of these data.

A 65-year-old man was brought to the emergency department with abdominal pain; acute pancreatitis was diagnosed. The patient had a history of alcohol abuse and exposure to asbestos. He underwent treatment for acute pancreatitis.

A chest film that was obtained when the patient was admitted to the hospital revealed massive calcification of the right parietal pleura, with a loss of lung volume on the right side (A). Bilateral crackles were heard in both lower lung zones.

Pleural calcification is a common manifestation of asbestos exposure. Asbestos exposure initially may cause pleural thickening that can later calcify. Pleural effusions and mesothelioma also may be associated with the exposure.

Generally, the first manifestations of asbestos exposure are pleural plaques that later calcify. The pleural plaque is an area of collagen deposition associated with an inflammatory reaction.

The pleural calcification that arises from asbestos exposure commonly occurs along the diaphragm and can be bilateral. Calcification that results from remote hemothorax, pyothorax, and tuberculosis is associated with thickening of the pleura over the entire lung.

The latter presentation was noted in the chest film of a 75-year-old man who had undergone treatment for tuberculous empyema in Guatemala a few years before the scan was obtained (B).

Drs Duggal, Dhupa, Badhey, and Arunabh emphasize the need for a careful, thorough history. Information revealed by the patient can provide clues to the cause of the calcification, whether it be asbestos exposure, tuberculosis, hemothorax, or pyothorax.