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.
Alternative names: Geographic calcification pattern
Other associated named signs: Incomplete border sign (plaque margins blend with adjacent normal pleura/chest wall on radiographs)
References
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