Holly leaf sign, seen in asbestosis.

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

Pleural plaques almost exclusively involve the parietal pleura. The findings were incidental in the above patient.

Reference: Grainger & Allison’s Diagnostic Radiology Essentials.