Pleural Thickening
Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP This page has been fact checked by a Doctor of Nursing Practice who specializes in Oncology and has experience working with mesothelioma patients.
Sources of information are listed at the bottom of the article. We make every attempt to keep our information accurate and up-to-date.
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Diffuse pleural thickening is a disease that causes the pleura, layers of tissue around the lungs, to thicken.[1] Pleural thickening may be a symptom of mesothelioma and related conditions, or it may be benign. It causes difficulty breathing, shortness of breath, and chest pains.
What Causes Pleural Thickening?
While pleural thickening is a common result of asbestos exposure, asbestos is not the only cause of this condition.[1] Pleural thickening can also be a symptom of another illness. When someone is exposed to asbestos over a long period of time, the fibers of this mineral often lodge in tissues like the lungs and pleura. In the pleura, asbestos fibers can trigger inflammation, resulting in fibrous scar tissue and collagen deposits. Pleural thickening caused by asbestos is often benign but may also be caused by malignant mesothelioma.
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Another medical condition that causes pleural thickening is a type of inflammation called fibrinous pleurisy and empyema. This condition is an accumulation of mucus in the space between the pleura. A pulmonary embolism, a blood clot in the vessels leading to the lungs, may also cause pleural thickening.
Localized areas of thickening are called pleural plaques. These are not the same as diffuse pleural thickening. Plaques may precede malignant tumors but do not cause symptoms like difficulty breathing.
Symptoms
Pleural thickening is progressive, worsening with time. In earlier stages, it may not cause many symptoms, much like mesothelioma. This is why anyone exposed to asbestos should be screened early and often. As thickening worsens, a person may experience breathlessness and chest pain.[2]
When pleural thickening becomes severe, it may lead to a condition called restrictive lung disease. This occurs when the lungs become so encased in fibrous scar tissue that they cannot fully expand. This causes decreased lung volume and forces the patient to work harder just to breathe. When this condition becomes severe, it can lead to respiratory failure and death.
Diagnosis
Pleural thickening does not develop in everyone who is exposed to asbestos, but it is not uncommon. If you were exposed to asbestos on the job, regular screening for lung problems is important. Diagnosis for pleural thickening usually begins with a description of symptoms, which include shortness of breath and chest pain, combined with known asbestos exposure.
After a physical exam, the next step is imaging the chest cavity. Imaging scans can show thickening, plaques, and other abnormalities in the chest. A chest X-ray is a typical first screening; although, it may not show everything necessary for diagnosis. A CT, or computed tomography scan, gives a clearer picture of what is happening in the lungs and pleura. These scans are high resolution and allow doctors to distinguish between pleural thickening and pleural plaques.
Distinguishing between benign pleural thickening and malignant mesothelioma is not easy. A doctor may choose to follow a CT scan with a PET scan (positron emission tomography) to help determine if thickening is benign or cancerous.[2] While this may not be enough for a firm diagnosis, it can determine if a biopsy is necessary. If pleural thickening is greater than one centimeter or there are nodules in the tissue, these are signs the thickening is malignant.
Treatment
Early diagnosis is important because pleural thickening is progressive. It will only worsen without treatment. If caused by mesothelioma, early treatment is especially important. Damage caused pleural thickening cannot be reversed, though treatment can slow progression and relieve symptoms.
Pain medication is a common treatment for benign pleural thickening. A doctor may also prescribe bronchodilators to dilate airways. In addition, a patient may receive steroids to reduce inflammation.
Decortication surgery can remove some of the restrictive fibrous scar tissue; however, this is not a common procedure, especially if the thickening is related to other asbestos conditions like mesothelioma.[2] Few mesothelioma patients are good candidates for surgical treatment, but for those who are, surgery can relieve symptoms of pleural thickening.
Other treatment strategies include respiratory aides, like oxygen tanks and respirators.[2]
Outlook
The outlook for diffuse pleural thickening is highly dependent on several factors. If the underlying condition can be treated, the outlook is typically positive. If the underlying cause is mesothelioma, prognosis is poor. Mesothelioma is challenging to treat and nearly incurable. Treatments at an early stage may be successful at relieving symptoms and slowing the progression of damage to the pleura. Unfortunately, reversing the damage is not possible.
If you have been diagnosed with pleural thickening and believe you were exposed to asbestos, talk to your doctor about the possibility of mesothelioma. Insist on screening for this type of cancer, but also understand what your options are for treating the symptoms of pleural thickening. With treatment and good management, you can experience some relief from this uncomfortable condition.
Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP
Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.