Monday, 25 November 2013

Pleural disease – Pleural plaques – Misdiagnosis

The pleura is a thin tissue covered by a layer of cells (mesothelial cells) that surrounds the lungs and lines the inside of the chest wall.
C. Pleural plaques
Pleural plaques is a medical condition as a result of exposure to asbestos that lead to accumulated plagues within the pleural cavity(a). Many diseases such as pneumonia, breast cancer, and heart failure can affect the pleural space.,therefore, it is often a secondary effect of another disease process.
D.1. Misdiagnosis
According to Nigel Askew from the article factory, there are five main asbestos diseases including asbestos cancer that can develop following exposure to asbestos fibres: malignant asbestos mesothelioma cancer, asbestos lung cancer, asbestosis, asbestos pleural thickening and asbestos pleural plaques, however, doctors who do not regularly diagnose asbestos disease can misdiagnose (or be slow to give a diagnosis) what the condition is. This can lead to sufferers of asbestos disease wrongly concluding they do not have a right to make an asbestos claim(20)
1. Pleural mesothelioma
In the study designed to examine the association between pleural plaques on computed tomography (CT) scan and the risk of pleural mesothelioma in a follow-up study of asbestos-exposed workers, indicated that a total of 17 incident cases of pleural mesothelioma were diagnosed. A statistically significant association was observed between mesothelioma and pleural plaques (unadjusted hazard ratio (HR) = 8.9, 95% confidence interval [CI] = 3.0 to 26.5; adjusted HR = 6.8, 95% CI = 2.2 to 21.4 after adjustment for time since first exposure and cumulative exposure index to asbestos)(19).
2. Asbestos-related pleural abnormalities
In the study to study the observer agreement in several asbestos-related pleural abnormalities and to define criteria to discriminate between pleural changes in workers with occupational disease, and those in controls, found that the extent, calcification and thickness were well-repeatable indicators of benign pleural pathology and thus their use in future classification systems in computed tomography is recommended. In our material, the extent of 45 cm(2) and the degree of calcification were helpful in discriminating between pleural changes in workers with occupational disease, and those in controls who also presented marked pleural pathology(21).
3. Parietal pleural plaques
According to the study lead by Svenes KB, in a series of 402 consecutive autopsies, parietal pleural plaques (PP) were found in 68 individuals above 40 years of age. The frequency of PP was 26.9% in males and 3.1% in females. In 28 cases chest roentgenographs taken shortly before death were available. These films were randomly mixed with chest roentgenographs from 33 subjects who had subsequently died and in whom no PP had been found at autopsy. All films were scrutinized by two experienced readers, ignorant of the case histories and autopsy findings. In less than half the PP cases was this diagnosis suggested from the roentgenological examination. On the other hand, the readers had 13 and 14 cases with positive or uncertain findings in the 33 cases with no PP found at autopsy(22)

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