CXR Case 042

A 63 year old lady presents having been diagnosed with a left pneumothorax in St Elsewhere

CXR CASE 042 CXR LITFL

Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

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


CLINICAL CORRELATION

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


CLINICAL PEARLS

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.


TOP 150 CXR SERIES



Prof Fraser Brims Curtin Medical School, acute and respiratory medicine specialist, immediate care in sport doc, ex-Royal Navy, academic| Top 100 CXR | Google Scholar |

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