V.c
Pleural thickening
Typically bilateral. Can predominate on one side. May encase the lung(s). Usually more prominent in the lower lung regions. Pleural effusion may predate or accompany pleural thickening. On imaging, notably CT, rounded atelectasis (the 'folded lung: Vo) can be present in intimate contact with the areas of thickened pleura. Pulmonary shadowing may be present en face areas of pleural thickening (so-called 'pleuropulmonary fibrosis'), an elective complication of ergot drugs. Pericardial thickening can also be present. Pneumothorax is a distinctive complication of alkylant- (CCNU, cyclophosphamide)-induced pleural thickening also named pleuroparenchymal fibroelastosis (Ix, Vp). Ergots can produce retroperitonal fibrosis with ureteral compression and consequent hydronephrosis. Pleural thickening can sometimes be tracer (18F-DG)-avid on PET-scan imaging