Plombage, also known as extraperiosteal or extrapleural pneumonolysis, is a historical treatment method for cavitary tuberculosis of the upper lobes of the lungs. It was used in the 1930s, 1940s, and 1950s prior to the introduction of effective antituberculous drugs, when treatment of tuberculosis consisted of rest, isolation, and proper nutrition.
A cavity was created surgically underneath the upper ribs, and the space was filled with inert material. Candidate substances included Lucite (acrylic) balls 1, ping pong balls, oils, rubber sheets, paraffin wax, and gauze. As a result, the upper lobe of the lung would collapse. The theory was that a collapsed lung would heal more rapidly.
Possible complications included hemorrhage and fistulisation to pleura, airways, esophagus, skin, and major thoracic vessels 2, as well as infection, which has been reported to occur as late as 57 years after plombage 3.
Features at imaging depend on the material used. In case of Lucite balls, multiple rounded ring shadows are seen in the upper zone (usually unilateral), with associated chest wall deformity and resected ribs. Often, other signs of tuberculosis such as calcified granulomas or lymph nodes are seen.
History and etymology
The term plombage derives from the Latin word for lead, plumbum, a reference to the insertion of an inert substance into the pleural cavity.
- article on medical devices in the thorax
- 1. Mond DJ, Khan A. Images in clinical medicine. Lucite-ball plombage. N. Engl. J. Med. 1994;330 (24): 1723. doi:10.1056/NEJM199406163302405 - Pubmed citation
- 2. Moran A, Stableforth DE, Matthews HR. Treatment of late complications of plombage by simultaneous removal of plomb and decortication. Thorax. 1990;44 (12): 1051-2. Free text at pubmed - Pubmed citation
- 3. Gotoh S, Chohnabayashi N. Images in clinical medicine. Infection 57 years after plombage. N. Engl. J. Med. 2009;360 (23): e29. doi:10.1056/NEJMicm0707466 - Pubmed citation