Season 5 Case 26

History: chest pain. What happened to this lady?

Season 5 Case 26

Case 26

History: chest pain. What happened to this lady?


Answer:

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Answer: Thorocoplasty

What? You young en’s may not see many of these as this was a surgical procedure performed many years ago to treat chronic tuberculosis. Why?

Tuberuclosis mycobacterium is a strict aerobe so it likes Oxygen. The upper lobes get relatively good ventilation for the decreased perfusion when compared to the lower lobes, thus the upper lobes maintain a high Oxygen concentration providing a nice place for TB to hang out. Before the days of good multi-drug therapy, how could get rid of chronic TB? Get rid of the upper lobes. Thus, this procedure where the apical portions of thoracic cavity are essentially crush with or without rib removal. Destroy the upper lobes and you remove the environment for TB. Reference: https://radiopaedia.org/articles/thoracoplasty

So why isn’t it just bad trauma? Wouldn’t you expect the clavicle to be deformed if the upper thorax is that crushed?

And this brings up one of my favorite medical procedure: the plombage. huh? Well how about we don’t crush the rib cage, but instead we just collapse the upper lobe by putting stuff in the pleural space… like I don’t know… ping-pong balls (with or without anti-TB meds)? not to be missed: http://www.learningradiology.com/notes/chestnotes/pingpongballplombage.html