Nodular pleural thickening

Pleural nodules are actually understood in the same way as intestinal nodules, that is, the pleura on both sides are stuck together, which means they appear thickened. This disease can cause patients to experience symptoms such as difficulty breathing and dry cough. Patients in severe cases may even go into a coma. If a child gets this disease, he or she may have a low-grade or high-grade fever. This article introduces the causes and clinical manifestations of this disease. Let’s take a look.

Pleural thickening refers to the phenomenon that on the basis of pleural lesions, fibrin deposition and granulation tissue proliferation lead to fibrosis, which increases the thickness of the pleura. It is the result of exudative pleurisy or pleural effusion. Pleural thickening can be localized or extensive. Extensive visceral pleural thickening affects the respiratory function of the lungs, while extensive parietal pleural thickening can narrow the intercostal spaces and reduce the chest cavity. Most cases of pleural thickening do not require treatment, but those with severe symptoms of pleural adhesions should be treated surgically.

Causes and common diseases

1. Pneumothorax, dry cough, dyspnea, weakened breath sounds, coma, cold sweat, hemoptysis, pleural thickening, dry cough, etc.

2. Diffuse mesothelioma causes shortness of breath, exudative pleural effusion, weight loss, chest wall collapse, pleural thickening, pleural metastasis, etc.

3. Children with tuberculous pleurisy may present with low fever, high fever, difficulty breathing, weakened breath sounds, fatigue, and shortness of breath. When there is a large amount of effusion, the trachea moves to the healthy side. In the chronic stage , there is extensive pleural thickening, adhesion, and wrapping, and the chest may be sunken on the affected side, and respiratory movements and breath sounds may be weakened.

4. Tuberculous pleurisy causes night sweats, orthopnea, cyanosis, fatigue, dry cough, and dyspnea; if there is pleural adhesion and pleural thickening, the chest cavity on the affected side may sink, the intercostal space may narrow, and respiratory movement may be restricted.

5. Chronic suppurative pleurisy is characterized by hypoproteinemia, low fever, fatigue, chest pain during exhalation, narrowing of the intercostal spaces, empyema, severe thickening of the pleura, especially the parietal pleura, and inward receding of the chest wall.

6. Diffuse malignant mesothelioma bone metastasis, shortness of breath, chest wall collapse, pleural thickening, pleural effusion, etc.

Differential Diagnosis

1. Pleural adhesions refer to the adhesion of two layers of pleura together. This disease is caused by tuberculosis, pleurisy and chest injury.

2. Pleural metastasis mainly originates from the lungs, followed by the breast. Other common primary sites include the stomach, ovaries, pancreas, etc. Cancer causes changes in the intrapleural capillary pressure, colloid osmotic pressure, capillary permeability and intrapleural pressure, resulting in pleural effusion - malignant pleural effusion. Malignant pleural effusion is also known as carcinomatous pleurisy. Malignant pleural effusion is a common complication of advanced cancer. Clinically, once a cancer patient develops pleural effusion, it means that the lesion has spread locally or systemically.

3. Pleural calcification When there are organized blood clots or caseous necrotic substances in the pleural cavity, calcium salts may be deposited, forming pleural calcification. Pleural calcification is common in tuberculous pleurisy, purulent pleurisy and after traumatic hemothorax. Certain pneumoconiosis, such as talcosis and asbestosis, may also cause pleural calcification, and it is often bilateral. Pleural calcification often coexists with pleural thickening and adhesions.

Treatment principles

Most cases of pleural thickening do not require treatment and only cause mild chest tightness, which will be alleviated or disappear due to gradual compensation. Strengthening exercise, chest expansion exercises, and deep breathing are the best treatments. Extensive pleural thickening affects the respiratory function of the lungs. If the symptoms of pleural adhesion are severe, surgical treatment should be performed, such as pleural decortication. However, the effect of surgical treatment cannot satisfy both doctors and patients. It causes great pain to patients and is prone to cause new pleural adhesions and pleural calcification.