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Prepared by Dr Simon Taggart, February 2006
Inhalation of mild to moderate concentrations of asbestos dust over varying periods of time can result in the formation of pleural plaques within the linings (pleura) of the lungs. These plaques are about the size and thickness of a holly leaf and can be seen on a chest x-ray. When they become coated in a layer of calcium, they can be seen on a standard chest X-ray and are then referred to as calcified pleural plaques. They may be single or multiple and be situated on the pleura or diaphragms. They are not in themselves harmful to health and cause no impairment to breathing. However their very presence is an indication that an individual has been exposed to significant levels of asbestos in the past and is therefore at a slight increase in risk of developing other lung problems. In general, calcified asbestos pleural plaques are seen between 20 and 40 years after original exposure.

Sometimes, the pleural plaque can cause a bit of the surrounding lung tissue to become stuck against it. This attachment tends to cause twisting of the lung rather like a guy rope pulling on a tent sheet, and in time causes the lung to twist over on itself. This can be seen on a chest X-ray as a small rounded area of tissue about the size of a ping-pong ball. This is called "round atelectasis" or folded lung and is not harmful to health.

Occasionally and for unknown reasons, the asbestos fibres appear to irritate the pleura in a way that they release fluid into the chest cavity causing the development of a benign pleural effusion. This fluid may cause symptoms of breathlessness and chest restriction during breathing and can be seen on an X-ray. If detected in this way, the fluid can be removed and prevented from coming back by introducing a chemical sealant into the lungs during a procedure called pleurodesis. Many asbestos related benign pleural effusions go unnoticed and eventually heal on themselves. However, they do have a tendency to cause more extensive thickening of the pleura, which may lead to slight difficulty with breathing on exertion. This type of injury is called diffuse pleural thickening, as it tends to be more extensive than pleural plaques.

Dr Taggart is a Consultant Physician in Chest & General Medicine at Trafford General & Salford Royal Hospitals NHS Trust. He is the Lead Lung Cancer Clinician at the two Trusts and has considerable experience in the field of chest medicine in particular industrial lung disease.