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Case of the Week 287

What's the most likely diagnosis?

  • 85 year-old male with shortness of breath

  1. Large left pleural effusion
  2. Atelectasis of left lung
  3. Left pneumonectomy
  4. Tension pneumothorax on right
  5. Thoracoplasty for TB

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5. Thoracoplasty for TB



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General Considerations

·         Defined as a “remodeling or reshaping of the thorax; especially, the operation of removing the ribs, so as to obliterate the pleural cavity in cases of empyema”

·         Thoracoplasty was used from the early 1900’s through the late 1950’s as one of the more permanent forms of collapse therapy for TB

o       Frequently used as a last resort in gravely ill patients

·         Collapse therapy was based, at least in part, on the observation that healed tuberculous cavities were closed and not open

o       The therapies were directed towards closing the cavities

·         When this procedure was relatively common, the average TB patient required  removal of 6-8 ribs

o       This was frequently done in stages of 2-3 ribs per operation

o       The remaining chest cage was then pushed toward the mediastinum, passively collapsing the upper lobe

·         Thoracoplasty for TB was replaced by anti-tuberculous drugs

o       Surgical treatments of TB were later directed at resection of the diseased portion of the lung instead of collapsing it

·         Thoracoplasty is still used for chronic infections of the pleural space and as surgery in patients with scoliosis

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