The Drug-Induced Cardiotoxicity Website and App

XIV.h

XIV - Pleural involvement

Pleural thickening - Fibrothorax

Last update 17/06/2026

Typically bilateral. Can predominate on one side. May encase the lung(s). Usually more prominent in the lower lung regions. Pleural effusion may predate or accompany pleural thickening. On imaging, notably CT, rounded atelectasis (the 'folded lung: Vo) can be present in intimate contact with the areas of thickened pleura. Pulmonary shadowing may be present en face areas of pleural thickening (so-called 'pleuropulmonary fibrosis'), an elective complication of ergot drugs. Pericardial thickening can also be present. Pneumothorax is a distinctive complication of alkylant- (CCNU, cyclophosphamide)-induced pleural thickening also named pleuroparenchymal fibroelastosis (Ix, Vp). Ergots can produce retroperitonal fibrosis with ureteral compression and consequent hydronephrosis. Pleural thickening can sometimes be tracer (18F-DG)-avid on PET-scan imaging

Causative drugs

Frequency - Incidence

Incidence of cardiac adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for cardiac adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic