Pleural Calcification: Causes and Clinical Approach

Etiology and Clinical Features

Asbestos exposure is the most common cause of pleural calcification, presenting as bilateral calcified pleural plaques typically appearing 20+ years after initial exposure, according to the American Thoracic Society 1, 2
The American College of Chest Physicians notes that asbestos exposure accounts for the vast majority of pleural calcifications, with multiple bilateral lesions being almost invariably associated with asbestos 1, 3
Calcified pleural plaques appear in chest films of 2.3% of U.S. males and are the most common manifestation of asbestos exposure, as reported by the American Journal of Respiratory and Critical Care Medicine 2
The European Respiratory Society states that calcification typically develops 20+ years after first exposure, with prevalence directly related to duration from initial exposure 2, 3
Central calcification within plaques is common, appearing as sharply demarcated lesions on the parietal pleura, particularly on the lower posterior thoracic wall and diaphragm, according to the British Thoracic Society 1, 3

Pleural calcification, particularly from asbestos, can cause restrictive lung disease with approximately 5% reduction in FVC even without interstitial fibrosis, as noted by the American Thoracic Society 3, 4
The American College of Chest Physicians reports that diffuse pleural thickening with calcification has greater functional impact than circumscribed plaques, with reductions of 270 ml in FVC 7, 6
The presence of asbestos-related pleural plaques indicates elevated risk of mesothelioma and lung cancer, serving as a marker for significant asbestos body burden, according to the International Agency for Research on Cancer 3, 4
Plain chest radiography is sensitive and appropriate for initial detection of pleural calcification, as recommended by the American College of Radiology 1, 2
HRCT is useful for questionable abnormalities and distinguishing pleural plaques from subpleural fat or other mimics, as suggested by the European Society of Radiology 1, 2, 4