PMC5571583_01
CT-scan of the thorax of 2014 with partially calcified plaque
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Fig1
He had been registered for the program years earlier when bilateral partially calcified pleural plaques had been discovered (Fig. 1). 
CT-scans of the thorax (left: 2013, right: 2014) showing identical levels of the costophrenic sinus, with a newly emerged large, smooth nodule paravertebral attached to the left chest wall (dimensions 21 x 13 mm, central calcification, no contrast material)
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Fig2
Situation of the parietal pleura close to the left costophrenic angle during operation with a spherical smooth mass (a) and multiple hyaline plaques (b)
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Fig3
Figure 3 shows the situation of the parietal pleura close to the left costophrenic angle during the operation with a spherical smooth mass (3a) and multiple hyaline plaques located in the same area (3b).
Histological image of the parietal pleura showing typical signs of a pleural plaque (fat tissue in the border area)
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Fig4
After histological analysis the removed tissue was described as a hyaline pleural plaque with central calcification and no signs of asbestos bodies or malignancy (Fig. 4).
CT-scans taken between 2005 and 2013 showing the growing nodule attached to the mediastinal pleura next to the oesophageal hiatus. The discovery of the presumably same nodule further down the sinus in 2014 triggered further diagnostic interventions
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Fig5
An extensive review of all available previous CT-scans of the patient going back to the year 2005 revealed a rounded opacity with central calcification which had been attached to the mediastinal pleura close to the oesophagus and slightly cranial to the position of the removed nodule (Fig. 5). That opacity started as a small nodule hardly discernible from the surrounding tissue and slowly increased in size until the year 2014 when it emerged lower down in the costophrenic sinus and was described for the first time (Figs. 5 and 6).
Location of a partly calcified nodule shown in lateral projection and comparing the situation in the years 2013 (left) and 2014 (right). It can be assumed that the dislocation of the nodule, later identified as a pleural plaque, took place sometime between the two scans. The dislocation was probably caused by physical exertions during a mountain hike and marked by an episode of thoracic pain shortly after the hike
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Fig6
That opacity started as a small nodule hardly discernible from the surrounding tissue and slowly increased in size until the year 2014 when it emerged lower down in the costophrenic sinus and was described for the first time (Figs. 5 and 6).