Study Syllabus for Classification of Radiographs of Pneumoconioses
Section 3: Pleural Abnormalities (Continued)
This image illustrates left-sided calcified face-on pleural plaques between the eighth and ninth posterior ribs, calcified in-profile plaques along the left lateral chest wall within the same area, and right-sided calcified face-on plaque in the area of the eighth and ninth posterior ribs. There is also blunting of the left costophrenic angle (Section 3C) but no diffuse pleural thickening (Section 3D). Other abnormalities include ca in the right upper zone, which must prompt notification of the worker’s personal physician.
This image illustrates calcified left-sided chest wall pleural plaques both in profile and face on. The total plaque extent is designated as 2 and the width of the in-profile component is b. There is also blunting or obliteration of the right costophrenic angle with an in-profile extension, which is classified as diffuse pleural thickening (see below), but no calcification or face-on component is identified. Bilateral calcified diaphragmatic plaques are noted as well. If a soft-tissue pleural plaque or calcification presumed to lie within such a plaque is identified, check the appropriate box R or L to indicate its location. If the finding is bilateral, check both R and L. If no pleural plaque (or calcification) is identified at any site, check O. When completing Section 3B of the classification form, you must mark at least one of the three boxes (R and/or L, or No).
The calcified soft-tissue shadow with sharp inner margins seen along the lower lateral chest wall on the right in Radiograph #16 represents in-profile plaque extent 1.
Radiograph #17A represents in-profile and face on plaques.
Radiograph #16 and Radiograph #17A
In-profile plaques are classified in terms of extent and width. In the 2011 revision, classification of width is termed optional.
Face-on plaques along the anterolateral/anterior or posterolateral/posterior chest walls are not classified in terms of width. Their extent is approximated and summed with the extent of the in-profile plaque (see below).
Extent. The extent of plaque involvement, noted as 1, 2, 3, is defined in terms of the vertical length of plaque in relation to the length of the lateral chest wall from costophrenic angle to lung apex. If only one in-profile or face-on plaque is present, vertical length is the length of that plaque in relation to the length of the lateral chest wall. If several in-profile or face-on plaques are present in the same hemithorax, vertical length refers to the sum of the lengths of all plaques present in that hemithorax, as described in the ILO guidelines document. Extent is classified as follows:
1) = total vertical length of plaque (sum of all plaques present, both in profile and face on) equal to one-fourth or less of the vertical length of the lateral chest wall
2) = total vertical length of plaque (sum of all plaques present, both in profile and face on) greater than one-fourth and up to one-half the vertical length of the lateral chest wall
3) = total vertical length of plaque (sum of all plaques present, both in profile and face on) greater than one-half the vertical length of the lateral chest wall