Plombage

Case contributed by Dr. Robert Niedermeyer

Presentation

SOB and chest pain.

Patient Data

Age: 85 years
Gender: Female

Plombage

X-ray

Portable chest radiograph reveals a large ovoid mass in the left upper lung.

CT

Large mixed fat and soft tissue density mass in the left lung apex.

Partially occlusive/nonocclusive pulmonary emboli in the bilateral lower lobe pulmonary arteries.

Small hiatal hernia.

 

Case Discussion

The patient presented to the ER for SOB and chest pain. No priors studies were available for initial chest radiography or CT interpretation. The patient was admitted for further workup of a left upper lobe lung mass. The further acquisition of past medical history was obtained by the admitting team which revealed a history of cavitary tuberculosis and was treated in the 1950s with plumbage therapy or pneumonolysis. The mass demonstrates predominantly fat density. Other commonly used agents that may produce similar imaging findings include olive/mineral oil or paraffin wax components used to fill the lung cavity.

The mass-like appearance of prior plombage therapy can easily be mistaken for a pulmonary neoplasm (possibly leading to an unnecessary lung mass biopsy) and highlights the importance of thorough clinical history or prior comparison studies when interpreting imaging studies.

The bilateral occlusive/non-occlusive pulmonary emboli in the bilateral lower lobe pulmonary arteries explain the patient's symptomatology.

Contributors:

Dr. Ademola Obajuluwa

Dr. Bourtai Gold

Maddie Jentink

Alexander Dills

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