Fibrothorax

Question 1

What is fibrothorax?

Answer 1

Localised or diffuse irreversible fibrotic transformation of pleura
Pleural thickening > 5mm extending to major portions of hemithorax

Question 2

What are the examination findings/signs of fibrothorax?

Answer 2

1. +/- trachea deviation
2. Shrinking of hemithorax
3. Dullness to percussion
4. Decreased vocal resonance (breath sound still present)

Question 3

What are the differential diagnoses for dull percussion and reduced vocal resonance?

Answer 3

1. Lung collapse
2. Collapse with effusion
3. Longstanding effusion with trapped lung
4. Mesothelioma

Question 4

What are the causes of fibrothorax?

Answer 4

Unilateral
1. Tuberculosis
2. Empyema
3. Haemothorax

Bilateral
4. Asbestosis
5. Connective tissue disease

Question 5

What is the complication of fibrothorax?

Answer 5

Diffuse pleural thickening causes marked reduction in lung volume and hypoventilation of affected lung

Question 6

What are the investigation for fibrothorax?

Answer 6

1. Lung function test - restrictive pattern
2. CXR - malignancy or active PTB
3. Lung biopsy

Question 7

How would you manage fibrothorax?

Answer 7

Decortication if significant functional impairment (VC < 60% predicted)