CXR Case 045
An 81 year old man is referred in from respiratory clinic for inpatient assessment of chronic type II respiratory failure
CXR 
CT chest
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Describe and interpret this CXR and CT chest
IMAGE INTERPRETATION
CXR Interpretation:
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.
CLINICAL CORRELATION
The combination of effectively a bilateral lobectomy and thoracic cage deformation has led to chronic ventilatory insufficiency
CLINICAL PEARLS
Plombage was a very effective treatment for TB, before antibiotics!
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 | ICIS Course ANZ