"Diffuse pleural thickening (DPT) is a well-recognized consequence of asbestos exposure and often follows a benign asbestos-related pleural effusion. At our tertiary center, in the North West of England where the prevalence of asbestos-related pleural disease is high, we have encountered a series of patients that have had led us to consider a new hypothesis in DPT. We postulate that non-asbestos-related pleural effusions, particularly transudative pleural effusions, caused by heart failure can trigger the development of DPT. We present one such case, discuss the limitations of our temporal observations, and invite further discussions from readers."

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