What causes Holly leaf sign in pleura on chest radiography?
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Answer:
Holly leaf sign represents irregular, spiculated margins of pleural plaques in asbestos-related pleural disease, appearing as thickened nodular edges on chest radiographs, typically in the parietal pleura of patients with prior asbestos exposure.
Why is it called so?:
Named for the resemblance of the irregular, spiculated, leaf-like margins of the pleural plaques to the jagged edges of holly leaves.
Pathophysiology:
Chronic asbestos fiber inhalation leads to pleural inflammation and fibrosis, resulting in deposition of laminated collagenous connective tissue forming discrete pleural plaques; tangential radiographic views reveal the undulating, nodular borders mimicking holly leaves, with calcification enhancing visibility in en face projections.
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