Pleural fibrosis is the development of fibrous tissue on the pleura, often caused by asbestos exposure or inflammation. In severe cases, it can impair lung function and require surgical removal. Diagnosis is made through chest X-rays and biopsies. Pleural calcifications may also be present.
Pleural fibrosis is a condition in which the pleura, the tissue that covers the lungs, develops fibrous tissue. Under normal conditions, the pleura is a very flexible mucous membrane, but when pleural fibrosis occurs, the pleura thickens and stiffens. The fibrous growth is benign, but can cause complications for the patient if it is widespread and may be associated with a disease process that could be harmful to the patient.
There are a number of causes for pleural fibrosis. It is often linked to asbestos exposure, and dissection of the pleura by a pathologist in severe cases often shows asbestos fibers embedded in the pleura, sometimes up to 15 years after exposure. It can also be caused by inflammatory processes, surgical trauma or pleural effusion. In mild cases, the condition causes small areas of fibrous tissue to develop that may not cause problems for the patient and are typically identified on chest radiographs taken for unrelated reasons.
In severe cases, the entire pleura can thicken, becoming very dense and white, almost like the pith in an orange, causing it to lose the elastic properties that normally allow the tissue to expand easily when the lungs are inflated. When the pleura thickens, the lungs have to work harder to inflate, and eventually the thickened tissue can impair lung function to the point where a patient cannot breathe or has extreme difficulty breathing. In these situations, the damaged pleura must be surgically removed so that the lungs can inflate.
Patients with the severe form tend to seek medical attention when they develop breathing difficulties. A doctor can diagnose the condition with tools such as a chest X-ray, a biopsy of suspicious tissue, and listening to the lungs. Biopsies are often recommended even in mild cases to confirm that the growth is benign, rather than cancerous, as the treatment for cancer is very different from the approach to pleural fibrosis.
It is also possible to see pleural calcifications associated with pleural fibrosis. In pleural calcification, small white plaques appear on the pleural membrane. In mild cases, these plaques may not be problematic, but they can become a cause for concern if they grow large, spread, or are associated with widespread pleural fibrosis. Fibrosis can also occur in the mucous membranes that surround other areas of the viscera, such as the heart and intestines.
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