Imaging Case of the Week 149 Answer

The chest x-ray shows pleural plaques more prominent on the right midzone, in the shape of a leaf. This is called the Holly leaf sign, seen in asbestosis. The bizarre plaques are bordered by calcified edges.

Holly Leaf SignPleural plaques almost exclusively involve the parietal pleura. They are distributed over the lower half of the thorax, commonly posterior and lateral. They can also be seen on the diaphragm and mediastinal pleura.

Reference: Grainger and Allison’s Diagnostic Radiology essentials.