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Spot diagnosis ( rare chest X ray )

Discussion in 'Spot Diagnosis' started by neo_star, Dec 18, 2012.

  1. neo_star

    neo_star Moderator

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    rare chest x ray.jpg

    click on the image to enlarge it
     

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    Last edited: Dec 18, 2012

  2. danielmx

    danielmx Active member

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    well that looks like "crescent moon signs" with multiple aspergillomas in the cavitations left by the previous TB.

    it can be treated with oral itraconazole for months or with surgical excision
     

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  3. neo_star

    neo_star Moderator

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    Hint : what u r seeing was actually a treatment method 4 TB in the 1950s, at a time when effective anti Koch's drugs were not available
     

  4. danielmx

    danielmx Active member

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    then, i have no clue. xD
     

  5. neo_star

    neo_star Moderator

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    Ok, this is very tricky and I don't see any more answers coming...so i will give the verdict and credit to Daniel for atleast trying

    The CT scan shows that the patient has previously been treated with plombage the insertion of inert balls made of Leucite extrapleurally inside the chest. These collapse the underlying lung.

    Plombage
    was a surgical therapy for TB used before antibiotic therapy was available.

    Other surgical treatments included crushing of the phrenic nerve (which leaves a small supraclavicular scar and a raised hemidiaphragm on the treated side) and thoracoplasty, in which the ribs over the upper lobe were removed. All these treatments collapsed the underlying lung and controlled TB by making the affected lobe underventilated and therefore hypoxic (as Mycobacterium tuberculosis requires aerobic conditions to grow).

    Antituberculous chemotherapy now means these operations are generally obsolete, although thoracoplasty may very rarely be used to control highly drug-resistant TB.

    Nowadays, the main relevance of these surgical treatments are the long-term complications. Thoracoplasty causes a restrictive lung function impairment which can lead to type 2 respiratory failure that responds well to chronic nocturnal non-invasive ventilation, and plombage can become infected or cause pressure effects on local structures.

    (-:
     

  6. dr.angela

    dr.angela Bronze Member

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    The therapy with plombage
     

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