An 81 year old man is referred in from respiratory clinic for inpatient assessment of chronic type II respiratory failure
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Describe and interpret this CXR and CT chest
There are bilateral multiple ring shadows in both apicies and scattered calcification, more prominent in the left apex.
The trachea is deviated to the right and may be narrowed.
There is associated 2nd, 3rd, and 4th rib destruction bilaterally.
The remaining lower lobes parenchyma appear normal.
CT Chest Interpretation:
Bilateral upper zone plombage is associated with complete destruction of the upper lobes, and surgical rib removal / damage to the upper thoracic ribs.
The combination of effectively a bilateral lobectomy and thoracic cage deformation has led to chronic ventilatory insufficiency
Plombage was a very effective treatment for TB, before antibiotics!