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Study Syllabus for Classification of Radiographs of Pneumoconioses						Print
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										Radiograph ClassificationSubset 1Section 3: Pleural Abnormalities (Continued)
An in-profile plaque may be defined as one whose sharp medial margin is roughly parallel to the lateral chest wall and whose shadow merges with the rib edge and lateral chest wall along most of the length of the plaque. Face-on plaque (en face plaque) usually appears as a rounded or ovoid area of opacity without sharp margination on the frontal chest radiograph. At times, face-on plaque may show a sharp margin but may be distinguished from in-profile plaque by the fact that its shadow does not parallel the lateral chest wall or appear to merge with the rib edge. Some plaques may present both in-profile and face-on components as they wrap the chest wall.
Radiograph #15A Upper and Lower
**Radiograph #15A (Upper and Lower)** illustrates the typical appearance of both in-profile and face-on chest wall pleural plaques as well as diffuse pleural thickening.
On the left, the in-profile plaque begins at the level of the 6th posterolateral rib and extends down to the level of the 9th posterolateral rib. Medial to the in-profile plaque on the left are poorly defined areas of increased density representing face-on plaques. Do not confuse the scapula overlap on the left with in-profile plaque.
The right side shows a blunted CP angle which when contiguous with a pleural shadow extending superiorly, defines diffuse pleural thickening. The plaque seen on this radiograph has an in-profile and face-on component.
Other abnormalities include post cardiac surgical changes, a mitral valve replacement, and two artifacts from snaps on the patient’s gown.
Radiographic images of pleural plaques may include recognizable areas of calcification as demonstrated in the in profile plaque on the left – see arrow. The presence or absence of calcification is recorded for all plaques and separately for the right and left hemithoraces. When only calcification is seen, a plaque is also recorded as present at that site.
Radiograph #15B
This image illustrates chest wall face-on pleural plaques as well as bilateral diaphragmatic plaques, most of which are calcified. Uncalcified plaques are said to be the precursor of calcified plaques. On the right side, there are uncalcified face-on pleural plaques in the areas of the fifth and sixth posterior and lateral ribs. In addition, there are calcified *face-on* plaques overlying the seventh posterior rib on the right and fifth to eighth posterior ribs on the left. Note the rolled-edge or “holly-leaf” appearance of the calcified face-on plaques. There is also calcification within the soft tissue of the plaques along both hemidiaphragms. Please note that if calcification is identified along the chest wall or hemidiaphragms, the calcification may be consistent with that occurring within a plaque even though the soft-tissue component of the plaque is not seen. In this situation, Section 3B should be filled out to indicate the presence of both plaques and calcification. Scoliosis should be recorded under 4A, “Any other abnormalities” and in the appropriate checkbox in section 4C or as a comment in section 4E.RADIOGRAPHS #15 TO #17 (INTRO.)Page 2 of 7RADIOGRAPHS #15C TO #15D
							
					
							Last Reviewed:  April 26, 2023						Source: 	National Institute for Occupational Safety and Health
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        Syndicate homeStudy Syllabus for Classification of Radiographs of Pneumoconioses
Introductionplus icon
Preface
Appreciation to Contributors
Intent of the Self-study Syllbus
Getting Started
Clinical Overviewplus icon
Major Occupational Lung Diseasesplus icon
Pneumoconioses
Central Role of Diagnostic Imagingplus icon
Role of CT
Overview of Nonimaging Clinical Tools in Lung Disease Diagnosis
Appendix A
References
Pathology Overviewplus icon
Pulmonary Silicosis
Coal Workers’ Pneumoconiosis
Asbestos Pleuropulmonary Disease
Pathological-Clinical Correlations
References
Radiograph Classificationplus icon
SUBSET 1 – Radiograph Classification, #1 to #19plus icon
Introduction
Radiograph Identification
Section 1: Image Quality
Section 2: Parenchymal Abnormalities, #1 to #14
Section 3: Pleural Abnormalities, #15 to #19
Section 4: Any Other Abnormalities
Section 5
SUBSET 2 – Radiograph #20 to #27plus icon
Radiograph #20
Radiograph #21
Radiograph #22
Radiograph #23
Radiograph #24
Radiographs #25 to #27
SUBSET 3 – Radiograph #28 to #38plus icon
Radiographs #28 to #30
Radiographs #31 to #32
Radiographs #33 to #35
Radiographs #36 to #38
SUBSET 4 – Radiograph #39 to #46 (Small and Large Opacities)plus icon
Radiographs #39 to #40
Radiographs #41 to #42
Radiographs #43 to #44
Radiograph #45
Radiograph #46
SUBSET 5 – Classifications and Answer Keys, Radiographs #47 to #83
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