Pleural Thickening and Asbestos

Pleural Thickening and Mesothelioma

Pleural thickening isn’t cancer, but it can appear together with conditions like pleural mesothelioma or, in some cases, before it, so doctors monitor it closely. Asbestos can cause both pleural thickening and mesothelioma. If you have pleural thickening, see your doctor often. In some people, it gets worse and leads to more serious illness.

Key Facts About Pleural Thickening

• Diffuse pleural thickening develops in 5% to 13.5% of asbestos-exposed workers, according to the Journal of Occupational Medicine and Toxicology.
• More than 90% of mesothelioma patients experience pleural thickening, according to the American Journal of Roentgenology.
• Pleural thickening can significantly increase the risk of pleural mesothelioma.

Recent studies show finding pleural thickening early can lead to better care. Registered Nurse Sean Marchese says, “It can help find mesothelioma sooner. This means more ways to treat it and feel better.”

Types of Pleural Thickening

In pleural mesothelioma, pleural thickening is usually diffuse or focal. These terms describe how much of the lining is affected. The thickening can be noncancerous, cancerous or another type.

Each type affects the lungs differently. That changes how doctors treat it and what to expect.

Main Types of Pleural Thickening

• Diffuse pleural thickening: Scarring spreads across a large part of the lung lining. It often happens after heavy asbestos exposure.
• Focal pleural thickening: Scarring stays in one area. It’s usually milder than diffuse thickening.

Knowing what caused the thickening helps doctors plan care. They keep a close eye on both types to protect your lungs and catch signs of cancer early.

Diffuse Pleural Thickening

Diffuse pleural thickening means a large area of the lungs’ lining has scarring. This can make it harder to breathe. This type is strongly linked to heavy asbestos exposure. When inhaled asbestos fibers lodge in the pleura, the body’s inflammatory response triggers fibrous tissue buildup that can thicken the lining over 5 to 34 years, according to the Journal of Occupational Medicine and Toxicology.

Diffuse Pleural Thickening Types

• Benign pleural thickening: This type isn’t cancer. It happens when thick, fibrous tissue builds up in the lung lining.
• Malignant pleural thickening: This kind covers 50% or more of one pleura or 25% of both pleurae. It can be a sign of pleural mesothelioma.

Doctors recommend people with diffuse thickening regularly track their lung health. Without care, this condition could lead to pleural mesothelioma.

Focal Pleural Thickening

Focal pleural thickening means scarring in one small area of the lungs’ lining. It can happen after minor asbestos exposure or past infections. While it’s usually less serious, doctors still need to watch it closely.

Focal Pleural Thickening Types

• Apical pleural thickening: Scarring at the top of one lung.
• Biapical pleural thickening: Also called bilateral apical. Scarring at the top of the pleura and both lungs. This finding is common in people with a history of asbestos exposure or prior lung infections.
• Nodular pleural thickening: Scarring that forms small lumps or nodules.

Imaging scans can help find this condition early. Early care may lower the risk of more serious lung problems like mesothelioma.

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What Causes Pleural Thickening?

The main cause of pleural thickening is breathing in asbestos. Other causes include infections or chest injuries. Asbestos dust has tiny fibers that can get stuck in the lining of the lungs. Over time, these fibers cause irritation and scarring. This scar tissue can build up and lead to pleural thickening. Amphibole asbestos fibers, including crocidolite and amosite, are particularly associated with pleural disease because their needle-like shape prevents the body from clearing them.

Causes of Pleural Thickening

• Asbestos
• Chest or rib injuries
• Coronary artery bypass grafting (CABG) surgery
• Empyema (pus in the pleural space due to infection)
• Hemothorax (blood in the pleura from chest injuries)
• Infections such as tuberculosis or chronic pneumonia
• Lung tumors (benign or malignant)
• Malignancies, including sarcoma and lymphoma
• Pleural effusion or fluid buildup in the pleura
• Pulmonary embolism (blood clot in the lungs)
• Radiation exposure
• Use of medications such as cyclophosphamide or ergotamine

The Agency for Toxic Substances and Disease Registry has documented pleural thickening as one of the most common health effects of asbestos exposure. Discuss your risk for pleural thickening with your doctor. If you have a history of asbestos exposure, ask about regular screenings.

A classic review in the Journal of Occupational Medicine and Toxicology from 2008 looked at prospective studies of asbestos workers. The research showed diffuse pleural thickening developed in 5% to 13.5% of workers, often 3 to 34 years after first exposure.

What Are the Symptoms of Pleural Thickening?

The most common symptoms of pleural thickening are breathlessness, chest pain and coughing. Symptoms usually develop slowly and can be hard to notice at first. Catching these signs early can lead to better care and outcomes.

Common Pleural Thickening Symptoms

• Breathlessness
• Chest pain
• Coughing
• Fatigue
• Fever
• Pain when inhaling or exhaling
• Shortness of breath (dyspnea)

Some pleural thickening symptoms, like shortness of breath and breathlessness, often worsen with activity. Anyone with lasting breathing problems or chest discomfort should talk to a doctor. Regular screenings are crucial for preventing asbestos-related diseases. This is especially critical for those with known asbestos exposure.

How Doctors Diagnose Pleural Thickening

Doctors use X-rays, CT scans and MRIs to look for pleural thickening. Finding it early can help guide better treatment and improve outcomes.

They may also run tests to rule out other conditions like pleural plaques and pleural effusion. A pleural effusion is fluid buildup in the pleural space, and it can worsen shortness of breath. Pleural plaques are small, flat spots on the outside of the lungs, while pleural thickening is more widespread scarring that can make the lungs stiff. Doctors also check for signs of asbestos cancers, like pleural mesothelioma.

Telling your doctor about any asbestos exposure helps with a clear diagnosis. If you’re unsure about your diagnosis, getting a second opinion is always an option.

Biopsy

A biopsy removes a small piece of tissue from the lining of the lungs. Doctors look at it under a microscope to find out what’s causing the thickening.

Your doctor may use a needle or a small camera (thoracoscopy) depending on where the thickening is. The results help confirm a diagnosis and guide the best treatment plan for you. Recent research suggests CT-guided biopsies are also a safe and effective option for collecting pleural tissue. A 2023 study in Lung India found CT-guided biopsies are a safe and effective option for collecting pleural tissue.

Imaging Scans

Doctors use the same imaging scans for pleural thickening and mesothelioma. A CT scan of the chest is the most useful imaging test for showing the location and extent of pleural thickening. On chest X-rays, pleural thickening shows as a thick white line along the lung’s edge. PET scans and MRIs help tell pleural thickening apart from mesothelioma.

CT scans provide detailed images that help doctors map the thickening and plan next steps. These scans help catch problems early so treatment can start sooner.

Pam McWhorter shares with us how imaging scans that found pleural thickening eventually led to her husband’s pleural mesothelioma diagnosis. She tells us that after an X-ray, “They noted on his medical records that there was thickening on the outside of the left lung.” Then he had a CT scan. Pam tells us the CT scan report said, “‘Nodular thickening, suspect for mesothelioma, doctors should take immediate action.’”  After receiving that report, the family connected with a mesothelioma specialist who diagnosed Jim and began his treatment.

Jim McWhorter

Verified Asbestos.com Survivor

Pleural Thickening Was a Sign of Survivor’s Mesothelioma Journey to Come

Jim McWhorter was told an injury-prompted X-ray was clear, but pleural thickening was noted in his record. A later surgery found tumors. It turns out that the pleural thickening led to his pleural mesothelioma diagnosis.

Jim McWhorter

Verified Asbestos.com Survivor

Read Jim’s Story

Pleural Thickening Treatment

Pleural thickening has no cure, but treatment can meaningfully improve lung function and quality of life, especially when started early. But supportive treatment can help manage it. The best options are to quit smoking, stay active and do rehab.

Treatments That Ease Pleural Thickening

• Complementary therapies: Relaxation techniques and meditation may ease symptoms such as pain.
• Exercise: Respiratory exercises can improve cardiorespiratory functions.
• Medications: Doctors may use steroids to ease breathlessness.
• Oxygen therapy: Using inhalers may help less severe cases.
• Pulmonary rehabilitation: People perform breathing techniques and exercises over 2-3 weeks.
• Smoking cessation: Lung function may improve when patients stop smoking.

In severe cases, a surgical procedure called decortication may remove the fibrous tissue to help the lung expand. People with severe breathing issues may use portable oxygen tanks.

Doctors Who Treat Pleural Thickening

Pulmonologists and pleural specialists have the expertise to diagnose and treat pleural thickening. They can recommend follow-up care and watch your condition for signs of progression.

Our Patient Advocates can match you with a top specialist near you. Our team has been helping people find doctors since 2006.

Pleural Thickening Life Expectancy and Prognosis

Pleural thickening can restrict lung function and affect quality of life, but in most cases, it doesn’t shorten life expectancy on its own. When pleural thickening progresses to mesothelioma, outcomes depend on the stage of the cancer at diagnosis and what treatments patients qualify for.

To understand how much pleural thickening is affecting your lungs, doctors use a breathing test called a forced vital capacity test, which measures how much air your lungs can actually move. Research shows that mild pleural thickening typically reduces this to around 83% of normal, while thickening on both sides of the chest can bring it down to around 67% of normal. The lower that number, the more breathlessness a patient may experience and the more likely their doctor is to recommend specialist evaluation or pulmonary rehabilitation.

Catching pleural thickening early gives doctors the best chance to slow its progression and protect lung function. As Dr. Jacques Fontaine, director of the Mesothelioma Research and Treatment Center at Moffitt Cancer Center, tells us: “Mesothelioma usually presents in the chest… It presents with pain. It presents with plaques seen on an X-ray or a CT scan.”

Common Questions About Pleural Thickening

Is pleural thickening serious?

Pleural thickening is not always a serious condition. But if it’s left untreated, it can advance into other, more dangerous stages such as encasement of the lung. This condition causes restrictive lung disease. Pleural thickening is also a sign of significant asbestos exposure. Pleural mesothelioma’s main cause is asbestos exposure.

Can pleural thickening affect your lifespan?

In most cases, pleural thickening won’t affect lifespan. But this condition may be a sign of more serious underlying conditions. These include malignant pleural mesothelioma or other cancer. Your doctor will determine how serious your pleural thickening is with diagnostic tests.

What is the difference between benign and malignant pleural thickening?

Benign pleural thickening means cancer tumors did not lead to the thickened tissue. Fibrous tissue that builds on top of itself is the cause. Pleural mesothelioma or cancer that spreads from another location causes malignant pleural thickening

Can smoking cause pleural thickening?

Asbestos is the primary cause of pleural thickening. Some data indicates a correlation between smoking and the progression of pleural thickening. Smoking limits lung function. It’s also proven to be a cause of other respiratory diseases, such as lung cancer.

Have there been any asbestos lawsuits related to pleural thickening?

Yes, Miller v. Armstrong World Industries, Inc. in 1991 was a precedent-setting court case. Raymond Miller was an insulator who worked with asbestos products. He eventually developed pleural thickening. There is now an asbestos trust fund, the Armstrong World Industries Asbestos Trust. It accepts claims from people who were exposed to the company’s asbestos products and became ill.

What does pleural thickening look like on a CT scan?

On a CT scan, pleural thickening appears as a white or gray layer along the lining of the lung, typically measuring more than 3mm thick. Radiologists assess whether it’s spread across a wide area or concentrated in one spot, and whether the edges appear smooth or irregular. Smooth edges generally suggest a benign cause, while irregular or lumpy edges thicker than 1cm may prompt doctors to investigate further.

Can pleural thickening be reversed or cured?

Pleural thickening is generally permanent, but treatment can slow its progression and ease symptoms. Pulmonary rehabilitation, smoking cessation and medications can all help improve breathing. In severe cases, a surgical procedure called decortication may partially restore lung function.

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