CXR Case 042

There are multiple rounded ring shadows in the right upper lung, with overlying chest wall deformity.

*A central line has been inserted, its tip projects over the superior vena cava.
* A chest drain projects over the left mid-zone.
There is no associated pleural effusion.
* Median sternotomy wires are visible

This lady has had plombage for TB in the early 1950s.
Large bore drains are generally not indicated for 1st line secondary pneumothorax treatment!

Plombage, also known as extraperiosteal or extrapleural pneumonolysis, is an obsolete treatment method for cavitary tuberculosis of the upper lobes of the lungs.
A cavity is created under the upper ribs, and compression of the upper lobes is achieved by inserting an inert substance such as oil, paraffin wax or gauze.
As Mycobacterium tuberculosis is an aerobe – it dies when the ventilation to the upper lobe is abolished.