Study Syllabus for Classification of Radiographs of Pneumoconioses
Section 3: Pleural Abnormalities (Continued)
An in-profile plaque may be defined as one whose sharp medial margin is roughly parallel to the lateral chest wall and whose shadow merges with the rib edge and lateral chest wall along most of the length of the plaque. Face-on plaque (en face plaque) usually appears as a rounded or ovoid area of opacity without sharp margination on the frontal chest radiograph. At times, face-on plaque may show a sharp margin but may be distinguished from in-profile plaque by the fact that its shadow does not parallel the lateral chest wall or appear to merge with the rib edge. Some plaques may present both in-profile and face-on components as they wrap the chest wall.
Radiograph #15A Upper and Lower
Radiograph #15A (Upper and Lower) illustrates the typical appearance of both in-profile and face-on chest wall pleural plaques as well as diffuse pleural thickening.
On the left, the in-profile plaque begins at the level of the 6th posterolateral rib and extends down to the level of the 9th posterolateral rib. Medial to the in-profile plaque on the left are poorly defined areas of increased density representing face-on plaques. Do not confuse the scapula overlap on the left with in-profile plaque.
The right side shows a blunted CP angle which when contiguous with a pleural shadow extending superiorly, defines diffuse pleural thickening. The plaque seen on this radiograph has an in-profile and face-on component.
Other abnormalities include post cardiac surgical changes, a mitral valve replacement, and two artifacts from snaps on the patient’s gown.
Radiographic images of pleural plaques may include recognizable areas of calcification as demonstrated in the in profile plaque on the left – see arrow. The presence or absence of calcification is recorded for all plaques and separately for the right and left hemithoraces. When only calcification is seen, a plaque is also recorded as present at that site.
This image illustrates chest wall face-on pleural plaques as well as bilateral diaphragmatic plaques, most of which are calcified. Uncalcified plaques are said to be the precursor of calcified plaques. On the right side, there are uncalcified face-on pleural plaques in the areas of the fifth and sixth posterior and lateral ribs. In addition, there are calcified face-on plaques overlying the seventh posterior rib on the right and fifth to eighth posterior ribs on the left. Note the rolled-edge or “holly-leaf” appearance of the calcified face-on plaques. There is also calcification within the soft tissue of the plaques along both hemidiaphragms. Please note that if calcification is identified along the chest wall or hemidiaphragms, the calcification may be consistent with that occurring within a plaque even though the soft-tissue component of the plaque is not seen. In this situation, Section 3B should be filled out to indicate the presence of both plaques and calcification. Scoliosis should be recorded under 4A, “Any other abnormalities” and in the appropriate checkbox in section 4C or as a comment in section 4E.