CTICasesAsbestos-Related Pleural Plaques with Lung Distortion (Cheeto/Dorito Sign)
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Imaging findings
The patient presents with very large, exuberant pleural plaques, described as 'cheeto' and 'dorito' signs due to their thick, irregular, and sometimes tumefactive appearance. Around several plaques, there are gas pockets appearing next to the plaque, possibly representing torn lung or paracystic emphysema. There is also associated traction bronchiectasis, but some areas of gas don't appear like typical honeycombing, with relatively normal surrounding lung.
Key takeaways
These are dramatic asbestos-related pleural plaques, possibly causing mechanical distortion of the adjacent lung. The gas pockets might be due to the lung tearing or separating from adjacent alveolar walls as it attempts to move around the large, stiff plaques, forming small air pockets or paracystic emphysema. While indentation atelectasis and ground glass can be seen near plaques, this case also suggests true lung fibrosis with traction bronchiectasis and mechanical lung injury adjacent to the plaques, rather than purely asbestosis-related UIP.
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