Alfudhili Khalid M, Lynch David A, Laurent Francois, Ferretti Gilbert R, Dunet Vincent, Beigelman-Aubry Catherine
1 Radiodiagnostic and Interventional Radiology, CHUV-University Hospital, Lausanne, Switzerland.
2 Department of Radiology, National Jewish Health, Denver, CO, USA.
Br J Radiol. 2016;89(1057):20150792. doi: 10.1259/bjr.20150792. Epub 2015 Nov 5.
Diagnosis of pleural plaques (PPs) is commonly straightforward, especially when a typical appearance is observed in a context of previous asbestos exposure. Nevertheless, numerous causes of focal pleural thickening may be seen in routine practice. They may be related to normal structures, functional pleural thickening, previous tuberculosis, pleural metastasis, silicosis or other rarer conditions. An application of a rigorous technical approach as well as a familiarity with loco-regional anatomy and the knowledge of typical aspects of PP are required. Indeed, false-positive or false-negative results may engender psychological and medico-legal consequences or can delay diagnosis of malignant pleural involvement. Correct recognition of PPs is crucial, as they may also be an independent risk factor for mortality from lung cancer in asbestos-exposed workers particularly in either smokers or former/ex-smokers. Finally, the presence of PP(s) may help in considering asbestosis as a cause of interstitial lung disease predominating in the subpleural area of the lower lobes. The aim of this pictorial essay is to provide a brief reminder of the normal anatomy of the pleura and its surroundings as well as the various aspects of PPs. Afterwards, the common pitfalls encountered in PP diagnosis will be emphasized and practical clues to differentiate actual plaque and pseudoplaque will be concisely described.
胸膜斑（PPs）的诊断通常很简单，尤其是在有石棉接触史且观察到典型表现的情况下。然而，在日常实践中，可发现许多导致局限性胸膜增厚的原因。它们可能与正常结构、功能性胸膜增厚、既往肺结核、胸膜转移、矽肺或其他罕见情况有关。需要应用严格的技术方法，熟悉局部区域解剖结构，并了解胸膜斑的典型特征。事实上，假阳性或假阴性结果可能会产生心理和医疗法律后果，或延误恶性胸膜受累的诊断。正确识别胸膜斑至关重要，因为在石棉接触工人中，尤其是吸烟者或既往吸烟者/戒烟者，胸膜斑也可能是肺癌死亡的独立危险因素。最后，胸膜斑的存在可能有助于将石棉肺视为以两下叶胸膜下区域为主的间质性肺疾病的病因。本图文综述的目的是简要回顾胸膜及其周围组织的正常解剖结构以及胸膜斑的各个方面。之后，将强调胸膜斑诊断中常见的陷阱，并简要描述区分真正的胸膜斑和假胸膜斑的实用线索。
