Apical cap
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- updated 10 May 2022:
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Apical pleural cap refers to a curved density at the lung apex seen on chest radiographs.
Epidemiology
The frequency of apical pleural thickening increases with age 3. There may be a slightly greater male predilection 7.
Pathology
It arises from a number of causes:
-
pleural thickening/scarring
idiopathic: chronic ischaemic aetiology is favoured for most cases 4
secondary to previous apical infection: typically pulmonary tuberculosis
may be present in up to 10% of radiographs 2
-
haematoma
upper thoracic spine injury
fractured 1st rib
lymphoma: extending from neck/mediastinum
abscess within the neck/mediastinum
Distribution
It is often bilateral but if unilateral may be more common on the right 7.
-<p><strong>Apical pleural cap</strong> refers to a curved density at the <a title="Lung apex" href="/articles/apical-zone">lung apex</a> seen on <a title="Chest radiographs" href="/articles/chest-radiograph">chest radiographs</a>.</p><h4>Epidemiology</h4><p>The frequency of apical pleural thickening increases with age<sup> 3</sup>.</p><h4>Pathology</h4><p>It arises from a number of causes:</p><ul>-<li>-<a href="/articles/pleural-thickening">pleural thickening</a>/scarring<ul>-<li>idiopathic: chronic ischaemic aetiology is favoured for most cases<sup> 4</sup>-</li>-<li>secondary to previous apical infection: typically <a href="/articles/tuberculosis-pulmonary-manifestations-1">pulmonary tuberculosis</a>-</li>-<li><a href="/articles/radiation-induced-pulmonary-fibrosis">radiation fibrosis</a></li>-<li><a href="/articles/pleuroparenchymal-fibroelastosis">pleuroparenchymal fibroelastosis</a></li>-<li>may be present in up to 10% of radiographs <sup>2</sup>-</li>-</ul>-</li>-<li><a href="/articles/pancoast-tumour">Pancoast tumour</a></li>-<li>haematoma<ul>-<li>-<a href="/articles/thoracic-aortic-injury">thoracic aortic injury</a> <sup>5</sup>-</li>-<li>upper thoracic spine injury</li>-<li>fractured 1<sup>st </sup>rib</li>-</ul>-</li>-<li>-<a title="Lymphoma" href="/articles/lymphoma">lymphoma</a>: extending from neck/mediastinum</li>-<li>abscess within the neck/mediastinum</li>-</ul>- +<p><strong>Apical pleural cap</strong> refers to a curved density at the <a href="/articles/apical-zone" title="Lung apex">lung apex</a> seen on <a href="/articles/chest-radiograph" title="Chest radiographs">chest radiographs</a>.</p><h4>Epidemiology</h4><p>The frequency of apical pleural thickening increases with age<sup> 3</sup>. There may be a slightly greater male predilection <sup>7</sup>.</p><h4>Pathology</h4><p>It arises from a number of causes:</p><ul>
- +<li>
- +<p><a href="/articles/pleural-thickening">pleural thickening</a>/scarring</p>
- +<ul>
- +<li><p>idiopathic: chronic ischaemic aetiology is favoured for most cases<sup> 4</sup></p></li>
- +<li><p>secondary to previous apical infection: typically <a href="/articles/tuberculosis-pulmonary-manifestations-1">pulmonary tuberculosis</a></p></li>
- +<li><p><a href="/articles/radiation-induced-pulmonary-fibrosis">radiation fibrosis</a></p></li>
- +<li><p><a href="/articles/pleuroparenchymal-fibroelastosis">pleuroparenchymal fibroelastosis</a></p></li>
- +<li><p>may be present in up to 10% of radiographs <sup>2</sup></p></li>
- +</ul>
- +</li>
- +<li><p><a href="/articles/pancoast-tumour">Pancoast tumour</a></p></li>
- +<li>
- +<p>haematoma</p>
- +<ul>
- +<li><p><a href="/articles/thoracic-aortic-injury">thoracic aortic injury</a> <sup>5</sup></p></li>
- +<li><p>upper thoracic spine injury</p></li>
- +<li><p>fractured 1<sup>st </sup>rib</p></li>
- +</ul>
- +</li>
- +<li><p><a href="/articles/lymphoma" title="Lymphoma">lymphoma</a>: extending from neck/mediastinum</p></li>
- +<li><p>abscess within the neck/mediastinum</p></li>
- +</ul><h5>Distribution</h5><p>It is often bilateral but if unilateral may be more common on the right <sup>7</sup>.</p><p></p>
References changed:
- 7. Saito A, Hakamata Y, Yamada Y et al. Pleural Thickening on Screening Chest X-Rays: A Single Institutional Study. Respir Res. 2019;20(1):138. <a href="https://doi.org/10.1186/s12931-019-1116-9">doi:10.1186/s12931-019-1116-9</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/31277661">Pubmed</a>
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