What are the symptoms of pleural thickening?

Pleural thickening is generally related to pleurisy, but many friends do not pay attention to this disease. Generally, after the onset of pleural hyperplasia, the patient may not feel any discomfort, but after an imaging examination, the condition of the pleura can be clearly seen. If patients feel unwell, they should be examined and treated in time.

Etiology and pathology

Pleurisy is an inflammation of the pleura caused by a variety of diseases such as infection (bacteria, viruses, fungi, ameba, lung fluke, etc.), tumors, allergies, chemicals and trauma. Among pleurisy caused by bacterial infection, tuberculous pleurisy is the most common.

Pleural thickening and adhesions are the result of pleurisy or pleural effusion. There are two types of pleurisy: dry pleurisy (without pleural effusion) and exudative pleurisy (with pleural effusion). Pleural thickening is mainly caused by exudative pleurisy. Because the pleural effusion was not discovered and drained in time, it stayed in the pleural cavity for a long time, which stimulated the pleura. In addition, there was fibrin in the pleural effusion attached to the chest wall or granulation tissue proliferation, which caused the pleura to proliferate and thicken. If two layers of pleura adhere to each other, it becomes pleural adhesion. . Pleural thickening can be localized or extensive. Extensive visceral pleural thickening can affect the respiratory function of the lungs, while extensive parietal pleural thickening can narrow the intercostal spaces and reduce the chest cavity.

Clinical manifestations

Symptoms of pleurisy vary, but common symptoms include chest pain or difficulty breathing. The clinical diagnosis is based on the history of pleurisy and imaging findings.

Imaging findings

Localized pleural thickening and adhesions are common at the costophrenic angles, making the costophrenic angles blunt, shallow, or flat. Under fluoroscopy, it can be seen that the diaphragmatic movement is weakened in this area. The pleura may also have extensive laminar thickening and adhesions. If the thickness is not large and is located on the anterior or posterior chest wall, it may not cause obvious X-ray changes. When the pleural thickening reaches a certain thickness, the density of the affected lung field increases. When turned to the tangent position, a sharp shadow with clear edges may be seen between the inner edge of the thorax and the lung field. Extensive pleural thickening and adhesions can cause reduction of the intercostal space, displacement of the mediastinum to the affected side, scoliosis of the spine to the opposite side, and rise of the diaphragm. If the lesion is extensive, the hilum of the lung may be lifted and the trachea may be displaced to the affected side. There is another type of cord-like pleural adhesion, which is more easily seen in pneumothorax and lung compression collapse. It appears as a cord-like dense shadow with clear edges connecting the chest wall and one lung surface. Cord-like pleural adhesions are often pleural changes caused by lung lesions close to the pleura. It is common in tuberculosis and tends to occur in the upper lungs. Fluoroscopic observation of diaphragmatic movement can differentiate localized pleural thickening and adhesions from small amounts of pleural effusion.