Affiliations: University of Utah Hospital, Salt Lake City, UT,
Feinberg School of Medicine, Northwestern University, Chicago, IL
Correspondence to: Howard Mann, MD, Department of Radiology, 1A71 University Hospital, Salt Lake City, UT 84132; e-mail: email@example.com
In their informative review of asbestos-related pleural disease (March 2004),1Cugell and Kamp addressed the nature of radiographic opacities that may mimic pleural plaques on the lateral pleural surfaces on chest radiographs. They described one particular triangular-shaped opacity that projected over lateral rib shadows, and cited the work of Gilmartin,2 who ascribed these opacities to slips of the serratus anterior and/or external oblique muscles. Examples of these opacities are provided in Figure 3B. of the authors’ article, and Figure 1 of the article by Gilmartin.2
Credit for elucidating the precise nature of these opacities should be given to Kurihara and colleagues.3 Utilizing a simple but elegant model, they demonstrated that these opacities are due to x-ray photon attenuation effects that are produced when the anatomy of curved ribs is rendered on a two-dimensional radiographic image. Because it is difficult to describe the nature of the attenuation effect, I encourage readers to peruse the illustrations and images in the article by Cugell and Kamp.1
We thank Dr. Mann for bringing this report to our attention. When reviewing routine chest radiographs, the pleural surfaces often receive only cursory attention. Various pleural shadows can be easily misconstrued as localized areas of fibrosis, or plaques, and therefore may seem to be indicative of asbestos exposure. These shadows include companion shadows, subpleural fat, and the costal groove. Of course, the CT scan is a much superior modality for visualizing pleural abnormalities. Kurihara et al1 provided a detailed anatomic explanation for the appearance of pleural abnormalities on both chest radiographs and CT scans.
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