Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Collapse Therapy with Plombage for Pulmonary Tuberculosis
- Radiologic Findings
- Fig 1. Chest radiography shows radiolucent expansile lesion with fusion between the left third and fifth rib.
Fig 2,3. Chest CT shows internal low attenuation suggesting intraosseous fatty component. MR was recommended because of the possibility of liposarcoma from focal high attenuating area.
Fig 4-7. MR images show ovoid mass-like lesion of T2/T1 dark signal intensity without enhancement at the resection site of the left ribs.
- Brief Review
- Plombage was a surgical method used prior to the introduction of anti-tuberculosis drug therapy to treat cavitary tuberculosis of the upper lobe of the lung. The term derives from the French word "Plomb" (lead) and refers to the insertion of an inert substance in the pleural space. The technical medical term for plombage is Extraperiosteal/Extrapleural Pneumonolysis. The underlying theory of Plombage treatment was the belief that if the diseased lobe of the lung was physically forced to collapse, it would heal quickly. Collapse therapy with plombage has been proposed in the early 1950s in patients with persistent cavitary disease despite specific antimycobacterial drug therapy. This technique consisted of denuding the ribs overlying the diseased area, collapsing selectively the parenchymal cavities - the major sources of bacillary proliferation - and maintaining the collapse by filling the subcostal extraperiostal space with a "plomb. A variety of substances were typically used as a “plomb” and included air, olive or mineral oil, gauze, paraffin wax, rubber sheeting or bags and Lucite balls. The inserted material would force the upper lobe of the lung to collapse. Compared with staged extrapleural thoracoplasty from which it is descended, the major advantages of this procedure were as follows: (1) collapse was obtained with only one operation; (2) it did not cause any physical deformity; (3) it was applicable to poor risk patients; (4) it preserved lung function; (5) it was applicable to bilateral disease; (6) hospital stay was short; (7) it markedly reduced postoperative complications. When practiced, this procedure cured up to three-fourths of the patients but was abandoned after a few years, as were other surgical procedures, when the improvements of antimycobacterial chemotherapy made it sufficient to cure almost all of the patients. Complications after collapse therapy with plombage reported in the 1950s included basically local infection and mediastinal compression. The latter should be avoided by using a number of plombs just necessary to collapse the underlying cavities. More recent reports have related late local complications resulting from plombage inserted up to 40 yr earlier, including
- References
- 1.Am J. Respir. Crit. Care Med. 1998; 157:1609-1015
- Keywords
- Chest wall, Iatrogenic lung disease, Bacterial infection, Tuberculosis,