Pleural Calcification Differential Diagnosis
The following is a differential diagnosis for pleural calcification, categorized for clarity and emphasis on potential severity.
Single most likely diagnosis
- Asbestos-related pleural disease: This is often the most common cause of pleural calcification, especially in individuals with a history of asbestos exposure. The calcifications are typically seen on the diaphragmatic pleura and can be associated with other asbestos-related diseases.
Other Likely diagnoses
- Tuberculosis (TB): Pleural calcification can occur as a sequela of healed TB pleuritis. The calcifications are often seen in the form of eggshell calcification around a pleural effusion or as discrete calcified pleural plaques.
- Empyema: Chronic empyema, especially when caused by tuberculosis or other chronic infections, can lead to pleural calcification. The calcification may be seen as a thick, calcified pleural rind.
- Hemothorax: Chronic hemothorax, particularly when associated with trauma or bleeding disorders, can result in pleural calcification due to the organization and calcification of the hematoma.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignancy (e.g., mesothelioma): While less common than other causes, pleural calcification can be associated with malignant diseases such as mesothelioma. Early diagnosis is crucial for treatment and prognosis.
- Fungal infections: Certain fungal infections, like histoplasmosis or coccidioidomycosis, can cause pleural calcification, especially in endemic areas. Missing these diagnoses could lead to inappropriate treatment and poor outcomes.
Rare diagnoses
- Sarcoidosis: Rarely, sarcoidosis can cause pleural calcification, although this is less common than pulmonary or lymph node involvement.
- Wegener's granulomatosis (Granulomatosis with Polyangiitis, GPA): This autoimmune disease can occasionally present with pleural calcification among its myriad manifestations.
- Echinococcosis (Hydatid disease): In endemic areas, echinococcosis can cause pleural calcification due to the formation of hydatid cysts in the pleura, which may calcify over time.