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X-ray shows pleural thickening. Concerns? Treatment?

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Pulmonologist
Practicing since : 2003
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Dear Doctor,

My questions as follows :

1. My relative's X-ray is shown to have pleural thickening. What is the concerns of having pleural thickenings ? Does a person need any treatment for this ?
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1. I intend to hire a domestic helper. However her x-ray report indicates :
Faint Fibrocalcific densities (SCAR) at the right clavicular region with thickened pleural density at the right apex.

Impression : Pulmonary SCAR with subapical pleural thickening right.

a) Is she fit for work ?
b) Any indication of existing/previous TB, and whether is it healed ?
c) Any chance of recurrence if it has been healed ?
d) Will it be infectious ?
e) Advisable to hire her or not ?

Appreciate your reply.

Thanks.
Posted Tue, 2 Oct 2012 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 35 minutes later
Hi,
Thanks for posting the query on XXXXXXX After going through the query I would like to comment the following:

1. Your Relative's Xray shows pleural thickening. Normally in absence of any occupational exposure to asbestos, it most of the times indicates a past pleural infection. If the pleural thickening is does not hamper the functionality of the lungs as determined by lung function tests and also there are no clinical symptoms then there is no active management required most of the times.

2. Regarding the domestic worker:
a) Is she fit for work ?
Technically a pulmonary function test needs to be done prior to fitness. But if she is asymptomatic most probably she is fit to work.

b) Any indication of existing/previous TB, and whether is it healed ?
This most likely represents old healed TB.You can ask her a history of prolonged cough or history of anti TB medicines in the past.

c) Any chance of recurrence if it has been healed ?
Chances of recurrence depends on ones immunity and exposure to contacts. If there is no contact exposure and her immunity is good then chances of recurrence will be less. However any evidence of cough,unexplained fever, swelling in the neck , etc. should prompt immediate medical attention in her.

d) Will it be infectious ?
Only if she has cough and her sputum afb examination turns out to be positive then she will be infectious. By her current xray picture she seems to be non infectious.

e) Advisable to hire her or not ?
If she is fit to work and non infectious at present as is most likely, you can hire her as far as medical parameters are concerned.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: X-ray shows pleural thickening. Concerns? Treatment? 5 days later
1. Assuming no exposure to asbestos, will pleural thickening get worse with age of patient , will the person in question face a higher risk of having lung disease in future ? How to make the thickening back to normal ?



2. Domestic helper :



- If scar represents a healed past TB, will this person face a higher risk of / more vulerable to, having TB/other lung disease, compare to someone without the scar ?



- Even if she is not infectious at this moment with negative sputum afb examination result, any injection/precaution measures to protect her from future exposure to TB/other lung disease ?




Thank you.
 
 
Answered by Dr. Gyanshankar Mishra 8 hours later
Hi,
Thanks for the follow up query.
After going through the follow up query, I would like to comment the following:

1. Assuming no exposure to asbestos, will pleural thickening get worse with age of patient , will the person in question face a higher risk of having lung disease in future ? How to make the thickening back to normal ?

Ans: Pleural thickening normally does not progress in absence of symptoms. Pleural thickening is irreversible. A decortication surgery by a cvts surgeon can be done if the breathlessness is increased.


2. Domestic helper :

- If scar represents a healed past TB, will this person face a higher risk of / more vulerable to, having TB/other lung disease, compare to someone without the scar ?

Ans: Yes diseased lung has somewhat higher risk then a normal lung of getting re infected with TB if the immunity drops down.



- Even if she is not infectious at this moment with negative sputum afb examination result, any injection/precaution measures to protect her from future exposure to TB/other lung disease ?

Ans: Maintain her immunity good. Avoid all possible exposure with known TB patients. If coexisting diseases like hiv, diabetes then high risk hence screen for these diseases.
Also yearly influenza vaccination and 5 yearly pneumococcal vaccination will help prevent secondary infections.


I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist







































Thank you.
Above answer was peer-reviewed by
 
Follow-up: X-ray shows pleural thickening. Concerns? Treatment? 3 hours later
Hi doctor,

Thanks for your answers.

Some follow up queries :

1. In order not to worsen the existing pleural thickening, what are the DOs and DONTs ?

2. My relative is having a feeling of "not feeling smooth in the respiratory area, and have a SLIGHT desire of coughing - which can be normally avoided" - sorry for my improper description !

- What should he do to eliminate this feeling ? a) By medication
b) without any medication
- Is it a concern having such mild symptom ?

3. Will pleural thickening develops to other lung disease, e.g. asthma ... ?

Thanks again.
 
 
Answered by Dr. Gyanshankar Mishra 31 minutes later
Hi,
Thanks for the follow up query.
After going through the follow up query, I would like to comment the following:

1. In order not to worsen the existing pleural thickening, what are the DOs and DONTs ?

Ans: Never neglect any chest symptom if it develops in future, do get vaccinated for influenza and pneumococcus infections, Yearly pulmonary function tests if available are a good option, Chest expansion exercises under supervision of a physiotherapist.

2. My relative is having a feeling of "not feeling smooth in the respiratory area, and have a SLIGHT desire of coughing - which can be normally avoided" - sorry for my improper description !

- What should he do to eliminate this feeling ?
a) By medication
b) without any medication
- Is it a concern having such mild symptom ?

Ans: With pleural thickening such mild symptoms will be there. Just follow the advise given in the answer above. Medications are required only if there is any other respiratory condition associated with thickening.

3. Will pleural thickening develops to other lung disease, e.g. asthma ... ?

Ans: No pleural thickening per say does not develop into other lung disease like asthma which is a disease of the airways. However if pleural thickening increases then restrictive lung disease may develop, the chances of which are very less.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: X-ray shows pleural thickening. Concerns? Treatment? 1 hour later
Hi Doctor,

My last questions :

Will patient with pleural thickening be more prone to lung disease, compare to people without ?

Although p.thickening is irreversible, can regular exercise help to lower the chance of having future lung disease ? If yes, what is the best exercise you will suggest ?

Thanks again.

 
 
Answered by Dr. Gyanshankar Mishra 6 hours later
Hi,
Thanks for the follow up.
After going through the query, I would like to comment the following:

Will patient with pleural thickening be more prone to lung disease, compare to people without ?

Ans: Pleura is the covering of lung. Thus the lung covering is thickened and the underlying lung is normal in pleural thickening. However due to restriction in lung expansion , a patient with pleural thickening will be slightly more prone to lung disease in future compared to those without thickening but remember this is not a thumb rule and the patient may remain asymptomatic the whole life.

Although p.thickening is irreversible, can regular exercise help to lower the chance of having future lung disease ? If yes, what is the best exercise you will suggest ?
Ans: lung expansion exercises do help in this condition. Incentive spirometry is a good option. You may buy one incentive spirometer from the market and perform daily inspiratory maneuvers to lift a minimum of 2 balls/ you personal best. This should be initiated in presence of a physiotherapist.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
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