Give a differential for pleural calcification.
Pleural calcification has a wide differential that includes calcification following haemorrhage, infection, TB and asbestos. Bilaterality favours asbestos-related pleural plaque disease. Post baterial empysema or TB may have dependent or apical predilection. History of previous chest radiation and surgery may give clue to causes of pleural thickening and pleural calcification, chest wall/rib changes maybe present.
Which of the differentials is most likely in this case?
The symmetry and involvement of the diaphragmatic surfaces makes asbestos-related pleural calcification most likely.
Name some conditions related to asbestosis exposure.
Asbestos can cause parenchymal and pleural disease as well as increasing the risk of bronchial carcinoma. Pleural disease may result in effusion or pleural malignancy. Parenchymal disease includes fibrosis.
What does the presentation with breathlessness suggest?
Simple calcified pleural plaques should be asymptomatic, so respiratory symptoms should make you think about an additional underlying pathology.
Multiple geographic regions of pleural calcification (yellow dotted lines) are seen involving both the parietal pleura on the inside of the chest wall as well as over the diaphragmatic domes.