Pleural Thickening – Symptoms & Treatment Options

Pleural thickening is a term given to a non-cancerous lung disease that results from a severe scarring of the pleura. The pleura is a thin membrane that covers the surface of the lungs and scarring of this tissue causes the pleura to thicken and closes the space between the pleura and the lungs. Pleural thickening usually inhibits a person’s ability to breath and can also cause chest pain when breathing or coughing. Pleural thickening is also known as diffuse pleural thickening (abbreviated as DPT) and can occur with both malignant and benign pleural diseases. In some cases, pleural thickening is harmless. However, in many other cases pleural thickening can often develop into malignant lung cancer. Pleural thickening often develops as a result of pleural effusion (see below).

Pleural Thickening and Asbestos

Asbestos minerals in their natural form.

Pleural thickening is most commonly caused by exposure to asbestos fibers. Maritime and shipyard workers, construction workers and other workers whose profession involved working extensively with asbestos containing material (ACM) are most likely to contract pleural thickening, but anyone who has been exposed to airborne asbestos fibers for an extended period of time can contract pleural thickening. Along with asbestosis and mesothelioma, this condition is one of the most frequently diagnosed diseases resulting from exposure to asbestos.

Asbestos fibers under a microscope.

When microscopic asbestos fibers enter the lungs, they become attached to the pleura and can cause an inflammation of the pleural surface. This inflammation can cause scarring damage to the pleural tissue, which progressively worsens over time. The condition can be intensified by smoking or other lung problems.

Although most commonly caused by asbestos exposure, pleural thickening can also be caused by: certain drugs, lupus, radiation therapy and chemotherapy, pulmonary embolisms, tumors (both malignant and benign), serious infections and rib injury.

Figure A shows normal and healthy lungs, airways, pleura, and diaphragm.
Figure B shows lungs with asbestos-related diseases, including pleural thickening, asbestosis, lung cancer, and mesothelioma.

Symptoms of Pleural Thickening

Pleural thickening and other asbestos-related diseases usually don’t display any symptoms for decades.

Pleural thickening displays no symptoms in its early stages, which often causes many people to be unaware that they have contracted the disease. Later in the development of the disease, patients can experience difficulty breathing and pain in the chest area when breathing. Difficulty breathing is by far the most common symptom; more than 90% of patients diagnosed pleural thickening experience some difficulty breathing and approximately 10-15% experience extremely severe difficulty breathing. This usually becomes progressively worse as the disease develops.

In addition to difficulty breathing, other common symptoms include: chronic chest pain, reduced movement of the chest wall, a recurring harsh cough and a general decline in the functioning of the lungs. In some cases, pleural thickening may not display any physical symptoms at all.

Pleural thickening can also cause additional lung diseases in some patients, most notably restrictive lung disease, which is often fatal. This disease causes patients to have severe difficulty breathing due to a decreased lung capacity.

Individuals who worked with extensively with asbestos have an approximately 5-15% chance of developing pleural thickening. The disease usually lies dormant until 10-40 years after exposure to asbestos. Most patients don’t get diagnosed with pleural thickening until at least 10-15 years after their first exposure to asbestos.

Figure A shows healthy of the lungs, airways, pleura, and diaphragm. The inset image shows a more detailed view of the pleural space and the two pleural layers. Figure B shows lungs with pleural thickening. The inset image shows a more detailed view of the lung with inflamed and thickened pleural layers.

Methods of Diagnosis

A CT Scan is one of the most effective ways of detecting pleural thickening and related lung diseases.

If you suspect you have pleural thickening, get a diagnosis as soon as possible so you can take steps to prevent the disease from progressing into other serious conditions, including malignant pleural mesothelioma.

Doctors can perform various tests to determine whether an individual has pleural thickening. The most common are chest X-rays, CT scans and PET scans. An X-ray of the chest will show the size and location of the pleura in the lungs. An individual has Pleural thickening if the pleura is larger than normal and covers a greater than average percentage of the chest. A CT scan or MRI scan can be an even more effective and reliable method of detecting pleural thickening by showing a high-resolution image of the chest. This image can show the scarring that pleural thickening causes more clearly than an X-ray.

A PET Scan can be an effective way to identify lung diseases.

Also, PET scans are often used to determine whether a patient has pleural thickening or mesothelioma (a form of lung cancer also causes by asbestos exposure). Patients can develop both pleural thickening and mesothelioma. Many patients mistakenly believe that pleural thickening is lung cancer as the symptoms of lung cancer can be similar to the symptoms of pleural thickening.

As with most forms of lung disease, the earlier a doctor can make an accurate diagnosis, the more options there are available for treatments and pain-relief. The use of both CT scans and PET scans can help to make a more accurate diagnosis earlier in the development of pleural thickening and other related lung diseases. Unfortunately, the prognosis is usually the same – in almost all cases there is no cure for pleural thickening. However, several treatment options exist to reduce pain and slow the progression of the disease.

Treatment Options

There are a variety of options available to handle the symptoms of pleural thickening.

While there is no way to undo or reduce the damage to the pleura that the disease causes, there are several treatments that can help to alleviate the symptoms of pleural thickening. Pain medications such as antibiotics and steroids aim to reduce the pain caused by the tissue scarring and to help make it easier for the patient to breathe. As with most other kinds of lung disease, smoking and breathing in other toxic substances can further exacerbate the condition. Smoking greatly increases the risk of pleural thickening developing into lung cancer.

A doctor will review treatment options available to you.

For a few patients who were diagnosed with pleural thickening early in the diseases’ development, one form of treatment that has proved effective is pleurectomy surgery. This treatment is most commonly used for patients with mesothelioma and involves removing the pleurectomy that lines one of the patient’s lungs and then removing any tumors from the inside of the chest wall. This treatment, if effective, can allow the patient to retain the function of both lungs. You should discuss this treatment option with a qualified and experienced medical professional along with other options available to you before making any decisions. This treatment has only proved effective in a very small number of pleural thickening cases.

Related Diseases

Although most diagnosed cases of pleural thickening are the direct result of an individual working with asbestos materials and inhaling asbestos fibers, many other similar diseases can cause pleural thickening. The following diseases can also cause pleural thickening:

Pulmonary embolism – a pulmonary embolism is a blockage in one of the lung’s arteries usually caused by a blood clot that originated in another part of the body

Hemothorax – internal bleeding around the lungs usually due to a blunt trauma or a penetrating trauma

Pleurisy – inflammation of the tissue that lines the lungs and chest

Empyema – pus that has collected in the space between the inside of the chest’s wall and the lung

Pleural effusion – a condition that involves an excessive buildup of fluid around the lung area. Pleural effusion is far less serious than pleural thickening. Pleural effusion often develops in patients who later develop pleural thickening.

Pleural effusion in a patient’s lung. Pleural effusion often leads to pleural thickening in patients.

Pleural plaques is another similar lung disease that is often mistaken for pleural thickening. Pleural plaques are a buildup of rough scar tissue in parts of the pleura. Pleural plaques can sometimes develop in patients who later develop pleural thickening, and pleural plaques can exist alongside pleural thickening in the lungs.

Preventing Pleural Thickening and Related Lung Diseases with Effective Asbestos Awareness Training

Asbestos is an extremely hazardous material that is very common in our environment today. It was used extensively as a cheap fire-resistant material to construct ceiling tiles, floor tiles, roof tiles, paint, insulation, cement pipes and thousands of other products during from the 1940s to the 1990s. It’s crucial that employers, employees and homeowners know how to identify asbestos in office buildings, warehouses, schools and older houses. Identifying asbestos is not always easy, as products that contain asbestos often look very similar to other products that were not made with asbestos. Making sure all buildings receive a professional asbestos testing program and making sure that everyone on the premises takes an asbestos training course is the only way to ensure everyone’s safety and prevent others from contracting pleural thickening, asbestosis, and malignant lung cancer.