CXR Case 049

There is bilateral apical pleural calcification and upper lobe fibrosis, worse on the right.
Both hilar are elevated and there is volume loss on the right side, with deviation of the mediastinum and trachea to the right.

This is old TB.
*The volume loss is from the fibrosis and also a right-sided phrenic nerve crush – both contributing to the ventilatory failure

A phrenic nerve crush was one of several pre-antibiotic era surgical procedures for TB.

Patients have a small ~2-3 cm scar above their clavicle and a high ipsilateral hemidiaphragm.

*With the recent advent of multi-resistant TB there has been a resurgence of interest in which ‘historical‘ surgical procedures might need to make a come back