As of limiting cases Pleural plaques are difficult to distinguish from the norm mal anatomic shade. On the radiograph in the frontal projection parallel to the medial surface of the first three or four edges along the lateral chest wall, a vertical line of medium intensity can be seen. This line is created as a result of the imposition of muscles, endothoracic fascia and fat, but it can be distinguished from pleural plaques, since plaques rarely form above the third rib and are most pronounced at the level of VII and VIII ribs. Below the level IV ribs normal maximum width of the shadow plaques with stavlyaet 1 mm .
The front dentate and external oblique abdominal muscles (located on the radiograph next to the ribs) can also be mistaken for pleural plaques, as they form a chain of shadows in the intercostal spaces. These anatomical structures tours often viewed over VIII edge, but in some cases they may be located on the V-IX ribs. Nadra Bernie shadows formed by the muscles, similar to one or two well-defined triangle or two finding each other shadows. Typically, these shadows are easily distinguishable from the shadows to create Mykh pleural plaques, since the shadow produced by the muscles of one side of sharply delineated and the other disappears in the surrounding soft tissues. In some cases, the differential It can only be produced by radiograph in an oblique projection , since in an oblique projection these shadows disappear. Pleural thickening should be distinguished from Vneplevralnaya giro O Fat , which may be similar to pleural thickening on the posterolateral surface of the rib. For differential ciation in these cases, an oblique projection is used.
Pleural plaques are often seen on the diaphragm . In anterior frontal projection plaques usually localized are in the middle third of the diaphragm dome and at a distance less rarely 2.5 cm from the lateral chest wall. Most of the plaques are round or similar to a button and, with an irregular contraction of the diaphragm, they are difficult to recognize by the shape of the dome of the diaphragm.
Calcification of the pleura. As already mentioned, pleural plaques are often calcified . Through the 40 years since the Pin that asbestos in approximately 40% of patients have
Fig. 46. Calcified Pleven -sectoral plaque. and – the front straight radiograph of the thoracic cage of the patient, who had for 35 years a significant exposure to asbestos: Browse obyzvest Adding diaphragm and clearly pronounced nye bilateral seal environments it part of the lung fields, as well as areas of calcification in the pleura; b – front right oblique projection of the same patient; c – anterior left oblique projection of the same patient. In oblique projections, the calcification sites in the pleura are more distinct. Calcified pleural plaques may be just a personal
radiologically detectable calcification of the pleura . Calcified plaques are more often seen on radiographs than unstarified ones . If the X-ray beam is directed at blyash ku angle (tangentially), the calcification is similar to a tight line, usually intermittent, extending parallel but the chest wall, diaphragm, or the border of the heart . As in a typical subpleural hyaline plaque of the news centered closer to the center of the inner surface Nosta her ribs separates the line of lesser intensity. In a frontal direction of the x-ray beam produced The direct my image calcified plaque, which in this projection is an irregular irregularly shaped shadow of pronounced intensity. For Bo Lee a clear outline of calcified plaques recommended shots in oblique.
As compared with a conventional radiographic studies it more sensitive method of detecting asbestos blja nis a computed tomography . In a group of 36 patients using computed tomography pleural were detected in 75% of cases, while in usual hydrochloric radiograph its exhibit only 66% of cases , while CT has detected it is time to greater severity zheniya pleura than radiography. In particular, it is easy to identify lyalos defeat mediastinal pleura, and can be had from Remove pleural plaques from shadows of adjacent normal structures. Computed tomography is also a sense tion method of detecting calcification of plaque.
Differential diagnosis. Exposure to asbestos is is achieved not only cause local thickening or pleural calcification. Local, unspecified, unordered areas of thickening of the pleura can be observed in mesothelioma , metastasis to the pleura, lymphoma or myeloma . The thickening of the pleura in these diseases is usually unilateral. Local pleural thickening and callus ,. similar to asbestos pleural plaques may be observed smiling patient with a fractured rib. In such cases, the changes are usually one-sided, and the diagnosis indicates deformed anced edge . Pleural plaques like calcified and unqualified , can also be formed in cases of pneumoconiosis caused by such substances as tremolite talcum (mineral talc), mica, bakelite, lime, tin and quartz. However, the formation of plaques in these cases is probably due to simultaneous contact with asbestos .
Another major cause of diffuse pleural calcification is long in the pleura inflammation, such as hemothorax, empyema or repeated pnevmoto RARS tuberculous etiology. In these cases developed od nostoronnee thickening of the pleura, which is the crust, cover with INDICATES extensive layer of lime. Typically it thickened vistseral Nye pleura, and lime deposition occurs at the inner surface thereof .
Value X-ray examination. Bilateral formation of pleural plaques and calcification of the pleura indicate that the patient was in contact with asbestos. These pleural lesions are asymptomatic and do not entail disability. Since epidemiological studies have confirmed that the person in contact with asbes is more likely to develop lung cancer, the presence of pleural plaques indicates the need Prove Denia radiological examination of the patient every 6.
Expressed thickened of pleural left front direct chest radiographs hydrochloric cells.
The inner surface of the thickening is calcified . The patient was treated for pulmonary tuberculosis by creating repeated artificial pneumothorax.
12 month for the purpose of early detection of bronchogenic cancer. Obyz vestvlenie pleura in combination with interstitial infilt ratami is a sign of asbestosis .