From the Guidelines
Apical pleural plaques are benign and do not typically require specific treatment, but patients should undergo regular monitoring with chest imaging and receive pneumococcal and influenza vaccinations to prevent respiratory infections. The presence of apical pleural plaques is most commonly associated with asbestos exposure, though they can occasionally result from other causes such as tuberculosis or prior trauma 1. These plaques are fibrous thickenings of the pleura that typically develop at the apex or upper portion of the lungs. Some key points to consider in the management of apical pleural plaques include:
- Regular monitoring with chest imaging, typically annual or biennial chest X-rays or low-dose CT scans, to detect any changes or development of more serious asbestos-related conditions 1
- Pneumococcal and influenza vaccinations to prevent respiratory infections that could exacerbate any underlying lung condition
- Smoking cessation, as smoking significantly increases the risk of developing more serious asbestos-related diseases like lung cancer 1 The presence of pleural plaques serves as a biomarker of asbestos exposure and indicates a higher risk for developing other asbestos-related diseases, including mesothelioma and asbestosis, which is why ongoing surveillance is important even though the plaques themselves are not malignant or progressive 1. It is essential to note that the relationship between pleural plaques and malignant pleural mesothelioma (MPM) is still being researched, and while some studies suggest a positive association, others consider pleural plaques as merely a marker of asbestos exposure 1. In terms of lung function, the presence of pleural plaques can be associated with a small reduction in lung function, averaging about 5% of FVC, even when interstitial fibrosis is absent radiographically 1. However, most people with pleural plaques alone have well-preserved lung function 1. Overall, the management of apical pleural plaques should focus on monitoring, prevention of respiratory infections, and smoking cessation to minimize the risk of developing more serious asbestos-related diseases.
From the Research
Apical Pleural Plaques
- Apical pleural plaques are a type of pleural plaque that can be found in the apical region of the lungs.
- According to 2, pleural plaques, including apical pleural plaques, do not confer any additional lung cancer risk in asbestos-exposed subjects.
- The study 3 found that pleural plaques, including those in the apical region, are a specific sign of asbestos exposure and can be diagnosed using CT scans.
Characteristics of Apical Pleural Plaques
- Apical pleural plaques are typically bilateral and less than 1 cm thick, with calcifications in a high percentage of cases 3.
- The margins of apical pleural plaques are usually regular, and they can be found in the upper regions of the lungs 3.
- The presence of apical pleural plaques can indicate asbestos exposure, but they are not associated with an increased risk of malignancy 4.
Diagnosis and Imaging of Apical Pleural Plaques
- Chest X-ray and CT scans can be used to diagnose apical pleural plaques, with CT scans being more sensitive and specific 5.
- High-resolution CT scans can provide detailed images of the pleura and help diagnose apical pleural plaques 5.
- According to 6, the presence of pleural plaques, including apical pleural plaques, may be an independent risk factor for lung cancer death in asbestos-exposed workers.
Relationship with Asbestos Exposure and Lung Cancer
- The relationship between apical pleural plaques and lung cancer is still controversial, with some studies suggesting that they may be an independent risk factor for lung cancer death 6.
- However, other studies have found that pleural plaques, including apical pleural plaques, do not confer any additional lung cancer risk in asbestos-exposed subjects 2.
- Asbestos exposure is a well-known risk factor for lung cancer, and the presence of apical pleural plaques can indicate asbestos exposure 3, 4.