Thoracolithiasis: a rare and frequently underrecognized entity - a retrospective single-center study and narrative literature review

Our plain-English summary of Thoracolithiasis: a rare and frequently underrecognized entity - a retrospective single-center study and narrative literature review, by C. İşevi, M.G. Pirzirenli, B.C. Öten, et al (BMC Surgery, 2026).

The study

• Authors: C. İşevi, M.G. Pirzirenli, B.C. Öten, H. Kolcu, B. Çelik, Y. Büyükkarabacak
• Journal: BMC Surgery
• Published: 2026;26(1)
• Type of article: Review
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Thoracolithiasis is a rare benign pleural condition classically described as a freely mobile, calcified intrapleural loose body. Systematic data on non-mobile thoracolithiasis and its clinical context are scarce. This study aimed to characterize the clinical, radiologic, etiologic, and geographic features of non-mobile thoracolithiasis, to explore isolated versus secondary forms, and to identify scenarios in which these lesions mimic malignant pleural nodules.

Materials And Methods: This retrospective, observational study included adult patients diagnosed with thoracolithiasis at a tertiary thoracic surgery center between January 2010 and December 2024. Eligible cases had radiologic and/or surgical confirmation and complete clinical and imaging data. Demographic, clinical, radiologic, and surgical variables, including asbestos exposure and coexisting thoracic disease, were collected. Patients were stratified by sex, symptom status, calcification, and isolated versus secondary thoracolithiasis. Statistical comparisons used the Mann-Whitney U test and Chi-square or Fisher's exact test (two-tailed p < 0.05). A narrative review of the literature was conducted to contextualize the findings of the present cohort.

Results: Twenty patients with pathologically confirmed thoracolithiasis (mean age 64.0 ± 10.5 years; 70% male; 75% with a smoking history) were included. No lesion showed evidence of mobility on available imaging review or intraoperative assessment. 60% of lesions were non-calcified, with a mean maximum diameter of 29.4 ± 17.8 mm. Thoracolithiasis coexisted with lung cancer in 40% and with other thoracic disease in 30%; 30% were isolated. Patients with calcified lesions were older than those with non-calcified lesions (70.0 vs. 60.0 years, p = 0.023). Lung cancer occurred exclusively in older male smokers and was significantly associated with male sex (p = 0.010) and smoking history (p = 0.027). Isolated thoracolithiasis was more frequent in female non-smokers, and all isolated cases underwent diagnostic exploration (100% vs. 35.7%, p = 0.025). Asbestos-exposed patients (25%) originated exclusively from inland provinces, whereas most non-exposed patients resided in a coastal, non-asbestos-endemic region.

Conclusion: Non-mobile thoracolithiasis exhibits two clinically distinct patterns: a secondary type in older male smokers with thoracic malignancy, and an isolated type in non-smoking women without additional thoracic disease. Non-mobile, often non-calcified thoracoliths in low-risk patients frequently mimic malignant pleural nodules and may lead to avoidable thoracoscopic or open exploration. Recognizing this broader spectrum of thoracolithiasis may help refine diagnostic algorithms and reduce unnecessary invasive procedures.

© 2026. The Author(s).

In plain English

This retrospective study from the thoracic surgery department of Ondokuz Mayıs University in Samsun, Turkey, reviewed 20 adults diagnosed with thoracolithiasis between January 2010 and December 2024. The article also included a narrative literature review. Thoracolithiasis is a benign condition in which small nodules lie within the pleural space. They are classically described as calcified and freely mobile. No lesion in this series showed mobility, and 60% were non-calcified. Eight patients (40%), all male smokers, also had lung cancer. Six (30%) had no other chest disease, and all six underwent diagnostic exploratory surgery. Five patients (25%) had a history of asbestos exposure; the article does not name fiber types. All five came from inland provinces, while most unexposed patients lived in Samsun. Lung cancer occurred in 20.0% of exposed and 46.7% of unexposed patients, and the authors reported that asbestos exposure was not clearly associated with lung cancer. The authors described two patterns: a secondary type in older male smokers with lung cancer or other chest disease, and an isolated type mainly in non-smoking women that often mimicked malignant pleural nodules. They cautioned that the very small number of asbestos-exposed patients precludes firm inference.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective, observational, descriptive single-center case series, with an accompanying narrative (non-systematic) literature review
• Who was studied: 20 adult patients diagnosed with thoracolithiasis at the Department of Thoracic Surgery, Ondokuz Mayıs University Faculty of Medicine (Samsun, Turkey), January 2010 to December 2024. Mean age 64.0 years, 70% male, 75% with a smoking history. Most lived in Samsun province (12/20); others came from neighboring provinces and one from Baku, Azerbaijan.
• Exposure: History of asbestos exposure, recorded for 5 of 20 patients (25%). Fiber type, source and dose are not described. Smoking history was also analyzed.
• Main results:
  • No lesion in any of the 20 patients showed mobility on available imaging or at surgery.
  • 60% of lesions were non-calcified. Mean maximum diameter was 29.4 ± 17.8 mm.
  • Thoracolithiasis coexisted with lung cancer in 40% of patients and with other thoracic disease in 30%. 30% were isolated (no other thoracic disease).
  • Patients with calcified thoracoliths were older than those with non-calcified lesions (70.0 ± 7.4 vs 60.0 ± 10.7 years, p = 0.023).
  • Among the 20 patients, coexisting lung cancer was significantly associated with male sex (p = 0.010) and smoking history (p = 0.027).
  • All 6 isolated cases (100%) underwent diagnostic exploration (VATS or thoracotomy), compared with 35.7% of secondary cases according to the text (Table 2 lists 4 of 14, 28.6%); p = 0.025.
  • All 5 asbestos-exposed patients came from inland provinces (Amasya, Corum, Tokat), whereas most non-exposed patients lived in Samsun (p less than 0.001).
  • Lung cancer occurred in 20.0% of asbestos-exposed vs 46.7% of non-exposed patients (p greater than 0.05). The authors reported asbestos exposure was not clearly associated with lung cancer, symptoms, lesion size, density, or timing of diagnosis.
  • Coronary artery disease and hypothyroidism were more frequent in asbestos-exposed than non-exposed patients (80.0% vs 6.7% and 60.0% vs 0.0%). The authors said this should be interpreted cautiously given the small number of exposed patients.
  • All patients had PET-CT, and none of the thoracolith lesions showed abnormal FDG uptake.
• The authors' conclusion: The authors concluded that non-mobile thoracolithiasis showed two patterns. One was a secondary type, mainly in older male smokers with lung cancer or other significant thoracic disease. The other was an isolated type, mainly in non-smoking women without other thoracic disease, in whom the lesions often mimicked malignant pleural nodules and led to unnecessary diagnostic exploration. They regarded the asbestos and geography observations as unsuitable for firm inference.
• Limitations the authors state:
  • Single-center, retrospective series with a small sample (N = 20), limiting statistical power and generalizability
  • Only non-mobile lesions were included, so no comparison with mobile thoracolithiasis was possible
  • Referral and selection bias are likely because all patients underwent surgery
  • Formal mobility assessment was not available for every patient
  • The very small number of asbestos-exposed patients precludes firm conclusions about the geographic or asbestos-related pattern

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Thoracic Surgery, Asbestos Exposure, Lung Cancer, Endemic.

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