Pleural Thickening

Is Pleural Thickening Serious?

Pleural thickening is not always serious. The condition can be serious as it becomes more advanced and limits lung function. Pleural thickening may also be an indicator of a serious underlying condition. For instance, pleural thickening may be a sign of malignant mesothelioma cancer.

In some cases, pleural thickening can be benign. Benign pleural thickening is not caused by cancer and will typically not impede the normal functioning of the lungs. However, benign pleural thickening can restrict lung function if the thickening becomes too advanced. This may impair breathing.

Whether malignant or benign, pleural thickening cannot be cured. However, treatment can help manage symptoms.

02. Mesothelioma and Pleural Thickening

How Does Pleural Thickening Relate to Mesothelioma?

Pleural thickening in mesothelioma patients develops as a result of prolonged asbestos exposure. Individuals may ingest or inhale asbestos fibers, which may become trapped in the pleura. There, the fibers irritate the lung lining, causing chronic inflammation.

Over time, this inflammation can lead to severe fibrosis, or scarring, of the lungs. The accumulating scar tissue can become thick enough to keep the lungs from fully expanding when a person inhales.

According to studies, pleural thickening is common among mesothelioma patients.

• In one overview of past studies, researchers reported 88% of malignant pleural mesothelioma patients showed pleural thickening on CT scan images.
• In studies following patients over time, the incidence of asbestos workers who developed pleural thickening was between 5% and 13.5%. The workers developed the condition anywhere from 3 to 34 years after asbestos exposure.

03. Symptoms of Pleural Thickening

What Are the Symptoms of Pleural Thickening?

Pleural thickening can be a progressive disease, meaning the symptoms often become more severe over time. In early stages, pleural thickening is often asymptomatic. As such, the condition can be difficult to detect.

Common symptoms of pleural thickening include:

• Chest pain
• Cough
• Difficulty catching your breath
• Difficulty or inability to take a deep breath
• Fatigue
• Fever
• Pain when exhaling or inhaling
• Shortness of breath (dyspnea), especially after or during exertion

Individuals may experience additional symptoms depending on the cause of the pleural thickening.

Individuals experiencing any of these symptoms should contact a doctor. Though pleural thickening alone may not be serious, a doctor can conduct a thorough examination for an underlying cause.

04. Causes of Pleural Thickening

What Causes Pleural Thickening?

Pleural thickening can be caused by infection, asbestos exposure, injury and more. Exposure to lung irritants and infectious diseases are some of the common causes of pleural thickening.

Causes of pleural thickening include:

• Asbestos
• Empyema (buildup of pus in the pleural cavity)
• Hemothorax (excess blood in the pleural cavity)
• Infection, including tuberculosis or pneumonia
• Inflammation
• Injury to the ribs or chest
• Lung cancer
• Pleural effusions
• Pulmonary embolism
• Tumors (benign or malignant)

The cause can dictate the location, severity and progression of the pleural thickening. For example, pleural thickening caused by asbestos exposure typically develops in the visceral pleura and may be serious. Different causes may also impact which symptoms a patient experiences.

05. Diagnosis of Pleural Thickening

How Is Pleural Thickening Diagnosed?

Pleural thickening may be diagnosed with imaging scans, such as computed tomography (CT) scans. A physical examination may also help diagnose the condition.

Methods used to detect and diagnose pleural thickening include:

• Chest X-ray: Healthy pleurae are not visible on an X-ray, but thickening at the very edges of the lung/pleura may be visible.
• CT scan: CT scans can help detect irregular thickness of the pleura, even if the scar tissue is only a few millimeters thick.
• Magnetic resonance imaging (MRI): MRIs can be used to detect thickening and other pleural malignancies.
• Physical examination: A physician can check for physical symptoms, such as altered breathing sounds.
• Positron emission tomography (PET scan): Though rarely used, pleural thickening may also appear on a PET scan.
• Ultrasound: Ultrasounds generally only detect thickening more than one centimeter in thickness.

If your doctor believes pleural thickening may be a sign of cancer or another condition, they may order additional tests, including biopsies.

Differentiating Pleural Thickening From Other Pleural Diseases

Pleural thickening may also develop alongside other conditions, such as pleural plaques and pleural effusion. Though these conditions may develop together, they are distinct in how they form and present symptoms.

• Pleural effusion is the buildup of fluid between the pleurae.
• Pleural plaques are the buildup of gray/white tissue on the pleura and areas of benign thickening. This condition most commonly develops in the parietal pleura.
• Pleural thickening is the buildup of scar tissue. This can develop in the visceral pleura, the membrane covering the surface of each lung, or the parietal pleura, the lung’s outer membrane.

It’s important for the doctor to differentiate these pleural diseases to develop the appropriate treatment plan.

06. Treatment for Pleural Thickening

How Is Pleural Thickening Treated?

Many cases of pleural thickening do not require treatment and are not life-threatening. However, the condition may advance, and patient symptoms may become uncomfortable. In these cases, doctors may recommend pulmonary rehabilitation or cessation of smoking, if applicable.

Pulmonary rehabilitation may be able to improve symptoms and quality of life for patients. A specialist can develop a customized plan based on an individual’s needs. Some common recommendations for patients to remedy pleural thickening include:

• Exercising regularly
• Improving diet and nutrition
• Learning breathing strategies
• Learning how to conserve energy

In rare, serious cases, patients may undergo a pleurectomy and decortication (P/D) surgical procedure to help relieve symptoms.

Doctors may administer pleural thickening treatment in conjunction with treatment for the underlying cause. For mesothelioma patients, medical professionals may recommend regular respiratory function tests. These tests can determine how well the lungs are working and monitor disease progression.

Doctors perform respiratory function tests that look at:

• Analyzing the diffusing capacity, or the transfer of oxygen from the lungs to the bloodstream
• Testing the lung volume, or how much air the patient’s lungs can hold

With these results, doctors can make recommendations to try to improve lung function and manage symptoms.

It is important for patients to remember that pleural thickening may be a symptom of another, more serious disease.

07. Common Questions