Differential Diagnosis for Right Lower Hemithoracic Pleural Thickening and Calcifications
Single Most Likely Diagnosis
- Asbestos-related pleural disease: The presence of pleural thickening and calcifications, particularly in the lower hemithoracic region, is highly suggestive of asbestos exposure. Asbestos-related disease can lead to pleural plaques, which often calcify, and can cause adjacent subsegmental atelectasis due to fibrosis and inflammation.
Other Likely Diagnoses
- Tuberculosis (TB): TB can cause pleural thickening and calcifications, especially if the disease has been chronic. The presence of bronchial wall thickening and subsegmental atelectasis could be indicative of pulmonary TB with pleural involvement.
- Pneumonia with pleural involvement: Bacterial or fungal pneumonia can lead to pleural thickening and, in some cases, calcification, especially if the infection has been severe or recurrent. The adjacent atelectasis could be due to inflammation and fibrosis.
- Pleural fibrosis due to other causes: Other causes of pleural fibrosis, such as rheumatoid arthritis, systemic lupus erythematosus, or drug-induced pleural disease, could also present with pleural thickening and calcifications, although these are less common.
Do Not Miss Diagnoses
- Malignancy (e.g., mesothelioma, metastatic disease): Although less likely, it is crucial not to miss a diagnosis of malignancy, such as mesothelioma or metastatic cancer to the pleura, as these conditions have significant implications for treatment and prognosis. Mesothelioma, in particular, is associated with asbestos exposure and can present with pleural thickening and calcifications.
- Empyema: An empyema, or pus in the pleural space, can cause pleural thickening and, if chronic, calcification. This condition requires prompt diagnosis and treatment to avoid serious complications.
Rare Diagnoses
- Sarcoidosis: Sarcoidosis can involve the pleura and cause thickening and calcifications, although this is a rare manifestation of the disease.
- Erdheim-Chester disease: This rare form of histiocytosis can involve the lungs and pleura, leading to thickening and calcifications, among other findings.
- Lymphangioleiomyomatosis (LAM): LAM is a rare lung disease that primarily affects women and can cause pleural thickening and effusions, although calcifications are less common.