Pleural Thickening

Pleural thickening is also called diffuse pleural thickening and is considered to be a disease of the lungs. It happens when scar tissue is extensive enough to cause the pleural to thicken. The pleura are the double layers of tissue that line the chest cavity and lungs and in which tumors grow in pleural mesothelioma. Pleural thickening may be a symptom of mesothelioma and other related conditions or it may be benign and a result of exposure to asbestos.

This thickening of the pleural tissue can become severe and may completely enclose the lungs and fill in the space between the pleura and the lungs. It may cause a lot of difficulty breathing, shortness of breath, and chest pains. Pleural thickening is among the most common conditions diagnosed in connection with asbestos exposure.

What Causes Pleural Thickening

While pleural thickening is a common result of asbestos exposure, asbestos is not the only cause of this condition. It can also be a symptoms caused by other illnesses. When someone is exposed to asbestos fibers over a long period of time, the fibers of this mineral can get lodged in tissues, like the lungs and pleura. In the pleura those fibers may trigger inflammation and the resulting buildup of fibrous scar tissue as well as deposits of collagen. Pleural thickening caused by asbestos is often benign, but it may also be caused by malignant mesothelioma.

Other medical conditions that may cause pleural thickening include a type of pleural inflammation called fibrinous pleuritic and empyema, which occurs when mucus builds up in the space between the pleura. A pulmonary embolism, a blood clot in the blood vessels that lead to the lungs, may also cause pleural thickening. Localized areas of thickening in the pleura are called pleural plaques and are not the same as diffuse pleural thickening. The plaques may precede malignant tumors and do not cause the same symptoms, like difficulty breathing, as pleural thickening.

Symptoms

Pleural thickening is progressive and gets worse with time. In earlier stages it may not cause many symptoms, much like mesothelioma. This is why it is so important for anyone who has been exposed to asbestos get screened for these kinds of conditions early. As thickening gets worse a person may start to experience shortness of breath or breathlessness as well as chest pains.

When pleural thickening becomes severe, it may even lead to a condition called restrictive lung disease. This occurs when the lungs have become so encased in fibrous scar tissue that they cannot fully expand. This causes decreased lung volume and forces the patient to have to work harder just to breathe. When this condition becomes severe it can lead to respiratory failure and is ultimately fatal.

Diagnosis

Pleural thickening will not occur in every worker who was exposed to asbestos, but it is not uncommon either. If you were exposed to asbestos on the job, get screened for any kind of lung problems so that you can get treatment as soon as possible. Diagnosis for pleural thickening usually begins with a description of symptoms: shortness of breath, breathlessness, and chest pains combined with known exposure to asbestos indicates that thickening is likely.

The next step after discussing symptoms and a physical exam is to image the chest cavity. Imaging scans can show thickening, plaques, and other abnormalities in the chest. A chest X-ray is likely to be the first screening used, but it may not show everything. 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 can image and 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 related to mesothelioma. This still may not be enough to make a firm diagnosis, but it can suggest whether a biopsy is necessary to look for malignant cancer cells. Signs on images that make malignant mesothelioma a more likely diagnosis than a benign condition include pleural thickening that is greater than one centimeter and nodules in the tissue.

Treatment

Getting a diagnosis early is so important because pleural thickening is progressive. It will only get worse without treatment. And, if it is caused by mesothelioma, getting early treatment is especially important. The damage that has caused pleural thickening cannot be reversed or fixed, but treatment can slow the progression of the disease and help relieve symptoms.

Common treatments for benign pleural thickening include pain medications to reduce chest pains and make breathing easier. A doctor may also prescribe medications that dilate the airways, called bronchodilators, or steroids, which reduce inflammation. Both types of drugs can make breathing a little easier. A type of surgery called decortication may be used to remove some of the restrictive fibrous scar tissue. However, this is not often done, especially if the pleural thickening is related to other asbestos conditions like mesothelioma. Very few patients with mesothelioma are good candidates for surgical treatment, but for those who are, surgery can relieve symptoms of pleural thickening.

Other treatment strategies that may help include using respiratory aides, like oxygen tanks, or in severe cases, respirators. Smoking makes breathing more difficult and can worsen lung diseases like pleural thickening, so quitting is strongly recommended.

Outlook

The outlook for being diagnosed with diffuse pleural thickening is highly dependent on several factors. If the underlying condition causing it can be treated, the outlook is fairly good. If the underlying cause is mesothelioma, the outlook is not as good. Mesothelioma is challenging to treat and nearly incurable. Treatments at an early stage of the disease may be successful at relieving symptoms and slowing the progression of damage to the pleura, but reversing the damage is not possible.

If you have been diagnosed with pleural thickening and you believe you may have been 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 should get some relief from symptoms.