Presentation
Presented to the ED post collapse. A chest radiograph was carried out along other tests in the workup of collapse, which eventually was found due to a cardiac arrythmia.
Patient Data
There is volume loss in the left hemithorax. Several rounded ring shadows are seen in the left upper zone, with intervening radiopaque material. There is left upper chest deformity with several ribs missing or fractured. Calcified hilar lymph nodes are evident.
Left upper zone extra pulmonary man-made spheres, apparently interconnected, causing left upper lobe collapse. Several calcified mediastinal and bilateral hilar lymph nodes.
There is deformity of several left upper ribs with evidence of old fractures.
Appearances are consistent with left apical plombage for the treatment of tuberculosis.
Case Discussion
Plombage is a historical treatment for tuberculosis by means of creating lobar collapse. Plombage was carried out until the mid 1950s, so in practice this is expected to be encountered for some years to come.
In this case, the finding of plombage was purely incidental, but was further investigated with CT because of lack of prior imaging, and because of unfamiliarity with the radiographic appearances.
Example from the literature of Lucite-ball plombage excised postmortem1
Related article: Plombage, Medical Devices in the Thorax, Tuberculosis
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