To be able to: 1.Recognise the various appearances of pleural plaques 2. Recognise the mimics of pleural plaques 3.Differentiate simple pleural plaques from diffuse pleural thickening and malignant lesions on a chest radiograph 4. Understand the options for imaging pleural plaques 5.Be awareof the current medico-legal implications of pleural plaques

Pleural plaques are the commonest radiographic manifestation of, and are virtually pathognomonic for, asbestos exposure. The formation of pleural plaques can occur after relatively limited exposure to asbestos, which is in contrast to the greater exposure whichis required to causeparenchymal lung disease. The plaques are areas of fibrosis, affecting mainly the parietal pleura,which are thought to form secondary to an inflammatory reaction to fibres that reach the pleura via the lymphatic system. The time lag between exposure to asbestos and appearance of pleural plaques is...

Classic plaque appearances If calcified (only 10-15%)theyare well defined, often bilateral with an irregular outline (can resemble a holly leaf when seen en face): Fig. 1 Non-calcified plaques are more difficult to identify on plain films but are most readily identified if they lie on the lateral chest wall CTreadilyidentifiesboth calcified and non-calcified plaques: Fig. 2, Fig. 3 Classic plaque distribution Postero-lateral chest wall between the seventh and tenth ribs Lateral chest wall between the sixth and ninth ribs Dome of the diaphragm: Fig. 2...

The identification of pleural plaques has important implications for many patients. They not only signify previous asbestos exposure but could also mean the patient could claim compensation depending upon in which country the asbestos exposure took place. The ability to recognise pleural plaques on plain films and differentiate them from other asbestos related conditions, as well as those conditions which mimic the appearances of pleural plaques, is an important skill for any radiologist. Further clarification with alternative imaging may be required in certain circumstances.

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