Aetiology of pleural plaques

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Abstract
Pleural plaques were found in 644 (6·6%) of 9,760 photofluorograms taken in 1965 in a region of Pelhřimov district; the incidence was highest in the age group 66-70 years. The advanced age of those affected may be explained by the greater frequency of the causative agent in the past. The disorder was known in Pelhřimov district as early as 1930; it was then thought to be posttuberculous. The past history of the cases was uninformative; as a rule, the only common previous disease was pleurisy with effusion, occurring in 9·7%. The general condition of those affected was excellent; only 8% were aware of the fact that pleural lesions were present. The disorder was found mainly in farmers, familial incidence was common, and if two generations of one family suffered from the condition, the older generation was affected in 100%. Pleural plaques consist morphologically of limited areas of hyalinized collagenous connective tissue with calcium salt deposits. Tubercle bacilli could not be cultivated from the lesions. Mineralological analysis showed no evidence of silicates in the pleural plaques and a normal content in the lungs. The aetiological factor responsible for the development of pleural plaques in Pelhřimov district is not known, but asbestos cannot be implicated. The unknown noxious agent is carried to the pleura by the lymph and blood stream. Pleural plaques are an endemic disorder. The traditional view that lesions are post-tuberculous appears, in the region submitted to this study, to be a possible explanation.