What is Bilateral apical pleural thickening. This is thickening of the lung lining at the top portion of both lungs. It may also be called apical "capping". It is thought to be due to inflammation or swelling that happened in the distant past.
What causes apical pleural thickening?
There are many causes for apical pleural thickening, including:
- bacterial pneumonia
- chemotherapy
- infection
- lupus ( an important factor because it can cause inflammation to many parts of body)
What does apical lung scarring mean?
Apical pleural scarring is the result of a thickening of the membrane that covers the lungs, according to Radiopaedia.org. The causes of this thickening include asbestos exposure, a secondary infection due to pulmonary tuberculosis and radiation-induced pulmonary fibrosis. There is no known cure for this condition, and apical pleural thickening ...
What is an apical pleural thickening?
Apical pleural thickening: Thickening of the top-most portion of the pleura. This type is benign unless the pleura has thickened more than two centimeters. Focal pleural thickening: Thickening confined to one or more specific areas of the pleura. Diffuse pleural thickening (DPT): Thickening of 50% or more of either the left or right pleura.
What does pleural thickening mean?
Pleural thickening is a descriptive term given to describe any form of thickening involving either the parietal or visceral pleura. It can occur with both benign and malignant pleural disease. According to etiology it may be classified as: benign pleural thickening following recurrent inflammation following recurrent pneumothoraces
What causes apical capping?
Apical caps, either unilateral or bilateral, are a common feature of advancing age and are usually the result of subpleural scarring unassociated with other diseases. Pancoast (superior sulcus) tumors are a well recognized cause of unilateral asymmetric apical density.
What does apical cap mean in medical terms?
ap·i·cal cap a curved shadow at the apex of one or both hemithoraces on chest x-ray; caused by pleural and pulmonary fibrosis or, on the left, by blood from a traumatic rupture of the aorta.
What is apical pleural?
Apical pleural thickening: Thickening of the top-most portion of the pleura. This type is benign unless the pleura has thickened more than two centimeters. Focal pleural thickening: Thickening confined to one or more specific areas of the pleura.
What is left apical cap?
Extrapleural extension of mediastinal bleeding over the apex of the left lung was seen as an apical cap on the chest radiograph. Apical left extrapleural cap can be one of the earliest x ray manifestations of aortic rupture and should be excluded in the trauma setting.
Can pleural thickening be cured?
Unfortunately there is no cure for pleural thickening. Once the damage has been done it is irreversible. However, a person with this condition will have to undergo regular appointments at their GP and/or hospital as there is a possibility that their condition can develop into mesothelioma.
What is apical area?
the tip of a root or shoot in a plant where growth in length takes place by activity of the APICAL MERISTEM.
What is apical pleural scarring?
The apical cap is a fibroelastic scar involving the visceral pleura and lung parenchyma at the apex and is occasionally observed in healthy and asymptomatic individuals [5]. In 1974, Renner et al. [3] identified unilateral or bilateral apical cap shadows in 22.1% (n = 57) of 258 routine chest X-rays.
Is pleural thickening life threatening?
Pleural thickening alone is not enough to confirm that you have asbestos cancer. However, it can be a sign of significant asbestos exposure and indicate a high risk for mesothelioma. Advanced pleural thickening can cause restrictive lung disease with severe breathing difficulty.
Does pleural thickening get worse?
There is currently no cure for diffuse pleural thickening. However, the outlook (prognosis) is often good as, for many people, the condition does not worsen with time.
How is pleural thickening treated?
In most cases, no treatment is needed since the pleural thickening does not usually cause very severe symptoms. Stopping smoking, keeping active and pulmonary rehabilitation (PR) are usually the most helpful options. If your breathlessness is severe, surgery can very occasionally be considered.
What is the meaning of pleural thickening?
Pleural thickening refers to a thickening of the lining of the lungs, the pleura, which is a thin layer of membrane that covers the inside of the rib-cage as well as the outside of the lungs. Diffuse pleural thickening (DPT) is diagnosed when the pleura thickens to the extent that it causes breathlessness.
Can Covid cause pleural thickening?
Pleural abnormalities in COVID-19 are either less common or underappreciated. Localized pleural thickening adjacent to the parenchymal lesion and pleural retraction is seen in early disease. Pleural effusion occurs in a minority of patients.
What is apical scarring?
An apical scar is a scar that is found at the apex of a tooth from dense connective tissue. It is generally found after there has been a surgical procedure or endodontic treatments. The most common procedures that lead to these scars are procedures dealing with the root of a tooth.
What is bilateral apical pleural thickening?
Diffuse pleural thickening (DPT) is diagnosed when the pleura thickens to the extent that it causes breathlessness. This condition is frequently, but not exclusively, caused by exposure to asbestos dust and fibres. When pleural thickening is found across both lungs, it is referred to as bilateral pleural thickening.
Can Covid cause pleural thickening?
Pleural abnormalities in COVID-19 are either less common or underappreciated. Localized pleural thickening adjacent to the parenchymal lesion and pleural retraction is seen in early disease. Pleural effusion occurs in a minority of patients.
How to treat apical pleural thickening?
Treatment for apical pleural thickening can only be treated surgically as the hardened areas of the lungs are scar tissue and will need to be removed. Thus relieving the pressure off the lungs allowing them to expand freely.
Why does my apical pleural thicken?
Causes. There are many causes for apical pleural thickening as it is a result of any inflammation in the lungs. Some causes included; bacterial pneumonia, chemotherapy, infection and lupus. Lupus is a key factor as it causes inflammation to so many body tissues.
Why does apical pleural scarring occur?
Apical pleural scarring is the result of a thickening of the membrane that covers the lungs, according to Radiopaedia.org. The causes of this thickening include asbestos exposure, a secondary infection due to pulmonary tuberculosis and radiation-induced pulmonary fibrosis. There is no known cure for this condition, and apical pleural thickening and scarring reduces lung capacity, according to Pleural Thickening.
What is the term for an accumulation of pus in the pleura?
Empyema is an accumulation of pus in the pleura. Hemothorax takes place when too much blood is in the pleural space, and fibrinous pleuritis occurs when the pleura becomes inflamed. The Mesothelioma Center also states that a pulmonary embolism, or blood clot in the lungs, can cause scarring in the apical pleura. ADVERTISEMENT.
Does apical pleural thickening reduce lung capacity?
There is no known cure for this condition, and apical pleural thickening and scarring reduces lung capacity, according to Pleural Thickening. Apical pleural thickening and scarring usually occurs secondarily after an initial infection.
What is apical cap?
Apical caps, either unilateral or bilateral, are a common feature of advancing age and are usually the result of subpleural scarring unassociated with other diseases. Pancoast (superior sulcus) tumors are a well recognized cause of unilateral asymmetric apical density. Other lesions arising in the l ….
What causes apical caps?
Apical caps, either unilateral or bilateral, are a common feature of advancing age and are usually the result of subpleural scarring unassociated with other diseases . Pancoast (superior sulcus) tumors are a well recognized cause of unilateral asymmetric apical density. Other lesions arising in the lung, pleura, or extrapleural space may produce unilateral or bilateral apical caps. These include: (1) inflammatory: tuberculosis and extrapleural abscesses extending from the neck; (2) post radiation fibrosis after mantle therapy for Hodgkin disease or supraclavicular radiation in the treatment of breast carcinoma; (3) neoplasm: lymphoma extending from the neck or mediastinum, superior sulcus bronchogenic carcinoma, and metastases; (4) traumatic: extrapleural dissection of blood from a ruptured aorta, fractures of the ribs or spine, or hemorrhage due to subclavian line placement; (5) vascular: coarctation of the aorta with dilated collaterals over the apex, fistula between the subclavian artery and vein; and (6) miscellaneous: mediastinal lipomatosis with subcostal fat extending over the apices.
What is apical scar?
Neoplastic and nonneoplastic benign mass lesions of the lung. Apical cap, also referred to as apical scar, is a form of localized pulmonary fibrosis. Pulmonary pseudoneoplasms. More results ►.
Which branch of the pulmonary artery is the apical branch of?
apical branch of inferior lobar branch of right pulmonary artery
How common is apical capfibrosis?
Apical capfibrosis is relatively common and was seen in 47% of autopsy cases.
What is the pleural capping in a supine patient?
Bilateral apical pleural capping and widening of the superior mediastinal outline in a supine trauma patient. Appearance suggests aortic injury or substantial upper thoracic spine injury. There is a transverse fracture through the infraspinous portion of the left scapula body.
What is pelvic CT?
The pelvic CT was performed during the arterial phase to enable assessment for active arterial bleeding. Bilateral pubic rami fractures, left acetabular fracture and right sacral ala fracture through the anterior sacral foramina ( Denis zone 2 fracture ). There is diastasis of the pubic symphysis. No active arterial bleeding is demonstrated however there is extensive extra-peritoneal pelvic hemorrhage. There is a high probability of a posterior urethral injury or extra-peritoneal bladder injury which could be investigated with cystourethrography.
What is the apical cap?
Pathology. Apical caps consist mainly of extrapleural fat and a combination of parenchymal and to a lesser extent pleural fibrosis. On histologic examination the pleura is thickened by dense, sometimes hyalinized collagen, accompanied in some cases by small foci of mononuclear inflammatory cells.
Where is the apical cap located?
The apical cap is an irregular, nonhomogeneous opacity located at the extreme apex of the lung. The lower border is usually sharply marginated, but it is frequently tented or undulating ( Fig. 73.1 ). The cap opacity is of variable thickness (usually <5 mm in craniocaudal dimension) and of variable transverse diameter. It may be unilateral or bilateral. In patients with a cap related to prior tuberculosis, the apical opacity can measure more than 1 cm in thickness on the radiograph ( Fig. 73.2 ).
How do asbestos fibers reach the pleural surface?
Whereas microscopic fragments of asbestos fibers have been isolated from pleural plaques, it remains unclear how fibers reach the parietal pleura and if they are responsible for inflammation and fibrosis. Chrysotile fibers, fine, short, and especially fragmented fibers, are better able to reach the pleura and probably account for many of the pathogenetic and anatomic features of asbestos-related disease. Some have proposed that pleural plaques are the direct result of local inflammation of the parietal pleura from asbestos fibers that protrude out of the visceral pleural surface. However, there have been no confirmative pathologic data to support this. The most plausible explanation for plaque pathogenesis is that the asbestos fibers reach the parietal pleura by retrograde lymphatic drainage involving flow from the mediastinal lymph nodes to the retrosternal and intercostal lymphatics. Asbestos fibers may also embolize to the parietal pleura through the costal vascular supply. Plaques are located in the vicinity of stomas in the parietal pleura, so-called Kampmeier foci, where asbestos fibers are resorbed by lymphatic flow.
What is the function of the pleura?
The pleura acts not only as a protective barrier but as an immunologically and metabolically responsive membrane that is involved in maintaining a dynamic homeostasis in the pleural space. The mesothelial cells secrete glycosaminoglycans and other surfactant-like molecules to lubricate the pleural surface in addition to proinflammatory, antiinflammatory, and other immunomodulatory mediators, factors that promote deposition and clearance of fibrin, and growth factors and extracellular matrix proteins to aid in serosal repair. Pleural injury and fibrosis are characterized by disordered fibrin turnover. Interactions among mesothelial and inflammatory cells, cytokines, growth factors, and blood-derived products are important in the pathogenesis of tissue fibrosis. The exact timing of these interactions, as well as genetic factors, may be the difference between resolution of an injury, leading to normal repair and regeneration, and excessive matrix formation with fibrosis and scar formation.
How does pleural fibrosis occur?
For pleural fibrosis to develop, an increase in the extracellular matrix, characterized by a disorder in fibrin turnover, must form to allow the fibrotic process to continue. The fibrinous matrix is created by the release of coagulation proteins from the plasma in response to pleural space inflammation. A complex balance exists between procoagulant and fibrinolytic activities of the mesothelial cells. In exudative pleuritis, local equilibrium between these activities is disrupted, enhancing fibrin deposition. Exudative pleural effusions are characterized by increased procoagulant and depressed fibrinolytic activity, favoring fibrin deposition in the pleural space.
What are the factors that contribute to pleural injury?
Interactions among mesothelial and inflammatory cells, cytokines, growth factors, and blood-derived products are important in the pathogenesis of tissue fibrosis.
What is a pleural plaque on a chest radiograph?
The earliest manifestation of a pleural plaque on the chest radiograph is as a unilateral or bilateral thin line of soft tissue density under a rib in the axillary region, usually the seventh or eighth rib. Noncalcified pleural plaques are difficult to identify on the chest radiograph except when the x-ray beam is tangential to the plaque. The plaque appears in profile as a sharply marginated dense band of soft tissue ranging from 1 to 10 mm in thickness, paralleling the inner margin of the lateral thoracic wall. As with any extraparenchymal lesion, pleural plaques viewed en face can be difficult to see. They have a characteristically sharply defined medial edge and an ill-defined lateral margin, the so-called incomplete border sign ( Fig. 73.9 ). The holly leaf sign refers to the radiographic appearance of pleural plaques with irregular thickened nodular edges ( Fig. 73.10 ). The majority of asbestos-related plaques occur in the parietal pleura. Visceral pleural plaque formation is uncommon. The radiographic diagnosis of visceral pleural thickening is not reliable unless it occurs in the interlobar fissures ( Fig. 73.11 ). Recognition of a calcified pleural plaque in a thickened minor fissure or major fissure has been reported. These visceral plaques usually are associated with extensive parietal pleural disease.
What is the pulmonary apical cap?
Pleural thickening is a common finding on routine chest X-rays. It typically involves the apex of the lung, which is called ‘pulmonary apical cap’. On chest X-rays, the apical cap is an irregular density located at the extreme apex and is less than 5 mm in width [ 1 ].
What is an apical cap?
It is generally accepted that an apical cap is a distinct fibroelastic plaque in the lung that contains mature collagen and elastin fibers [ 6 ]. In 1970, Butler et al. [ 2] examined 48 autopsy lung specimens and noted mural thickening in the small muscular arteries subjacent to the apical cap and chronic bronchitis in more than half of the cases. Based on these observations, the authors concluded that an apical cap is a localized parenchymal lesion, which is presumably the result of persistent or repeated inflammation. They further postulated that the relatively decreased perfusion at the apex of the lung may impede the resolution of inflammation. More recently, Yousem [ 5] reviewed 13 surgically resected lung specimens with an apical cap and reported consistent pathological findings suggesting chronic ischemia as a major cause of an apical cap [ 5 ].
How much does pleural thickening increase with age?
The prevalence increased with age, ranging from 1.8% in teenagers to 9.8% in adults aged 60 years and older. Moreover, pleural thickening was clearly associated with greater height and lower body weight and body mass index, suggesting that a tall, thin body shape may predispose to pleural thickening.
What is pleural thickening on X-rays?
Although pleural thickening is a common finding on routine chest X-rays, its radiological and clinical features remain poorly characterized . Our investigation of 28,727 chest X-rays obtained from annual health examinations confirmed that pleural thickening was the most common abnormal radiological finding. In most cases (92.2%), pleural thickening involved the apex of the lung, particularly on the right side; thus, it was defined as a pulmonary apical cap. Pleural thickening was more common in males than in females and in current smokers or ex-smokers than in never smokers. The prevalence increased with age, ranging from 1.8% in teenagers to 9.8% in adults aged 60 years and older. Moreover, pleural thickening was clearly associated with greater height and lower body weight and body mass index, suggesting that a tall, thin body shape may predispose to pleural thickening. These observations allowed us to speculate about the causative mechanisms of pleural thickening that are attributable to disproportionate perfusion, ventilation, or mechanical forces in the lungs.
How common is pleural thickening?
Pleural thickening was more common in males (3.4%) than in females (2.7%; p < 0.01) (Additional file 1: Table S3), and the incidence increased with age, ranging from 1.8% in teenagers (17–19 years) to 9.8% in adults aged 60–83 years (Additional file 1: Table S4). It is worth noting that pleural thickening occurred in individuals as young as 18 years, and the prevalence increased markedly after the age of 40 years (Fig. 3 ).
Why is the ventilation rate at the apex of the lung higher than at the base?
Due to the effects of gravity, ventilation and perfusion rates are lowest at the apex and highest at the base of the lung in the upright position [ 9 ]. Furthermore, the ventilation/perfusion ratio is highest at the apex because ventilation is relatively greater than perfusion compared with other lung areas [ 9 ]. As such, it seems reasonable that the apex is more susceptible to chronic ischemia, which may explain why pleural thickening is found predominantly at the apex and in the upper portion of the lung (Fig. 2 ). Moreover, lower ventilation and perfusion at the apex may increase the risk of sustained exposure to pathogens or environmental irritants that can trigger the inflammation associated with pleural thickening. Furthermore, intrapleural pressure is more negative, and transpulmonary pressure is greater at the apex than in the lower portion of the lung [ 9 ]. Therefore, mechanical forces generated by repeated cycles of respiration may be greater at the apex, which may in turn promote the fibrotic response [ 10 ]. However, these pathogenic mechanisms remain a matter of speculation.
Which lung has a lower volume?
We found that pleural thickening occurred predominantly in the right lung. Anatomical differences may account for this finding. The left lung has two lobes and thus a lower volume than the right lung, which has three lobes, and the heart is located on the left side. Conceivably, there may be a greater ventilation/perfusion mismatch and stronger mechanical forces acting at the apex of the right lung than at the left lung.
