Differential Diagnosis for Apical Pleural Thickening and Volume Loss
Single Most Likely Diagnosis
- Pleural Asbestos-Related Disease: This condition is a common cause of apical pleural thickening, particularly when there is a history of asbestos exposure. The presence of volume loss in the right hemithorax suggests chronic disease leading to fibrosis and contraction of the lung tissue.
Other Likely Diagnoses
- Tuberculosis (TB): TB can cause apical pleural thickening due to chronic inflammation and scarring. Volume loss in the affected hemithorax is consistent with the chronic nature of the disease.
- Histoplasmosis: This fungal infection can lead to chronic lung disease, including apical pleural thickening and volume loss, especially in endemic areas.
- Sarcoidosis: Although less common, sarcoidosis can cause pleural thickening and volume loss, particularly if there is significant fibrosis in the lung parenchyma.
Do Not Miss Diagnoses
- Lung Cancer: It is crucial not to miss lung cancer, which can cause apical pleural thickening due to direct invasion of the pleura or secondary to obstructive pneumonitis. Volume loss can occur due to tumor growth or post-obstructive atelectasis.
- Empyema: An empyema, especially if chronic, can lead to significant pleural thickening and volume loss. It is a condition that requires prompt diagnosis and treatment to avoid long-term sequelae.
Rare Diagnoses
- Erdheim-Chester Disease: A rare form of histiocytosis that can involve the lungs and cause pleural thickening among other manifestations.
- Lymphangioleiomyomatosis (LAM): Although primarily affecting women, LAM can cause cystic lung disease and, in rare cases, may lead to pleural thickening and volume loss.
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis): This autoimmune disease can cause a wide range of pulmonary manifestations, including pleural disease, though it is less common.