What is pleural thickening?

Pleural thickening is the term used to describe the appearance of widespread scarring on the lining of the pleura. It is distinguished from pleural plaques by the amount of scarring; in the case of pleural plaques, the thickening from fibrosis is much more localised (so-called ‘focal scarring’ of the lungs). Some physicians consider that pleural plaques affect the outer pleura (parietal pleura) and pleural thickening the inner pleura (visceral pleura).

The causes of pleural thickening

The pleura is a thin cell membrane with two layers. It lines the rib cage on one side and the lungs on the other. The pleural cavity (the tiny space between the two layers) is filled with pleural fluid. This allows the two layers of the pleura to slide effortlessly between each other, which they do whenever the lungs expand or contract during breathing. It therefore plays an essential role in the proper functioning of the respiratory process. Sometimes, asbestos fibres inhaled by the patient will penetrate the pleura. This is particularly likely when the long, thin and straight fibres produced by blue and brown asbestos are inhaled, although patients have experienced the symptoms of pleural thickening having only been exposed to white asbestos.

This will trigger the body’s natural defence mechanisms in the pleura, leading to swelling and the release of white blood cells. Asbestos is an extremely durable material (it has previously been described as the ‘magic mineral’, in light of its impressive resistance to heat and pressure) however, which means that it is able to resist much of the immune system’s response. Though some fibres will be expelled and destroyed, many will remain in place. This leads to further swelling and the death of numerous white blood cells. Over time, the continual swelling process leads to scarring; this causes the pleural membrane affected to lay down fibrous tissue. This tissue eventually leads to thickening across the surface of the membrane in the form of white, fibrous lumps. This is known as pleural thickening.

Diagnosis and symptoms of pleural thickening

Pleural thickening is diagnosed primarily through an x-ray. The inflammation and permanent thickening caused by the presence of asbestos fibres makes the ordinarily extremely thin pleural membrane easily detectable. CT scans may also be used.

Often this condition is symptomless, which means that the diagnosis often results from the doctor looking for a more aggressive condition such as mesothelioma. As the patient will not experience any symptoms, treatment is not usually necessary. In some instances however, particularly where the thickening is extensive, the condition can cause difficulty breathing, tightness across the chest and pleural effusion (the production of excess pleural fluid). Breathing can usually be improved by the administration of medications designed to relax the lungs, so that they are better able to function. Where the pleural thickening is extreme, a pleurectomy can be used to remove the fibrous rind from the pleural membrane. This will allow the lungs to expand more easily.

Pleural effusion can usually be treated with a chest tube to drain the pleural cavity or the introduction of talc to remove the fluid. In severe cases, a surgical intervention can be used to fuse the two sides of the pleura together so that fluid cannot accumulate.

Pleural thickening, often being caused by the inhalation of asbestos fibres, is indicative of a higher than average risk of the patient developing other asbestos-related conditions (although the thickening itself is usually harmless). This means that a patient with pleural thickening should attend regular check-ups with their GP to monitor their condition. If the patient is a smoker, they should seek advice on giving up, because their already increased risk of going on to develop asbestos-related lung cancer will be significantly higher if they continue to smoke. In many cases, regular exercise will help patients to maintain lung functioning.

Next steps

If you have a history of exposure to airborne asbestos fibres and have concerns about your health, it is recommended that you visit your doctor.

Pleural thickening can form the basis of an asbestos compensation claim, provided that the thickening is sufficiently extensive to cause tangible symptoms. If you have been diagnosed with pleural thickening and would like to find out more about beginning a compensation claim, you should contact Humphreys & Co. Solicitors today. We have extensive experience of assisting the victims of pleural thickening, asbestosis, mesothelioma and other asbestos industrial illnesses. The impressive track record of our asbestos compensation team, even in difficult cases, means that we are ideally placed to guide you through this difficult process.