Plombage Thoracoplasty With Lucite Balls

Abstract

An 82-year-old male nonsmoker presented with hemoptysis. He had had a history of pulmonary tuberculosis in 1948 and underwent repeated artificial pneumothorax, pneumoperitoneum, and phrenic nerve crush, followed by extrapleural plombage with polymerized methyl methacrylate (Lucite) balls at the Royal Brompton Hospital. Chest radiograph (Fig 1) shows a number of Lucite balls surrounded by some scar tissue. Computer tomographic scan (Fig 2) of the thorax showed Lucite balls at the right apex. Air can be seen outside the balls, which suggests a communication between the plomb and lung parenchyma. This usually results in infection in the plomb. Bronchoscopy showed partial obstruction of the apical segment of the right lower lobe by granulation tissue with no evidence of malignancy. In this age group, further surgical treatment such as removal of the plombage material, prolonged drainage followed by softtissue transfer is a major undertaking. The patients’ symptoms were not severe and he was content to be followed up without treatment for the present. Plombage, a variant of collapse therapy that uses a variety of foreign materials, including Lucite balls (Fig 3), was undertaken in the late 1940s and ended in the 1950s. In the long term these can erode into the lung parenchyma, allowing infection to enter the plombage space. Eradication requires removal of the plomb and softtissue transfer or thoracoplasty to obliterate the space. Address reprint requests to Dr Tezel, Department of Thoracic Surgery, Royal Brompton Hospital, Sydney St, London SW3 6NP, UK; e-mail: mdcagatay@hotmail.com. Fig 1. Fig 2.