Prominent subpleural fat with chronic pleural disease

Imaging In the setting of a focal or diffuse pleural abnormality, the underlying subpleural fat can be thickened (Figures 67.1–67.3). This is likely due to hypertrophy secondary to chronic inflammation. As such, the presence of thickening of the subpleural fat is a strong indicator of chronic and, therefore, benign pleural disease (1–4). However, it should be stressed that thickened subpleural fat is not seen with every case of benign pleural disease and therefore the absence of thickening of the subpleural fat is not indicative of malignancy. Importance Recognition of thickened subpleural fat adjacent to a pleural abnormality is a strong predictor that the associated pleural abnormality is benign.