Late Complications of Thoracoplasty and Plombage for Tuberculosis

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Before the late 1940s, there was no effective chemotherapy for tuberculosis. Cavitary lesions were a sign of serious infection and signaled the failure of host defenses to contain the organisms. Efforts were made to mechanically close cavitary lesions with the hope that their closure might reestablish host containment of the organism. “Collapse therapy” was practiced in several forms: pneumothorax therapy, pneumoperitoneum, plombage, and thoracoplasty.This article focuses on the latter two modes of therapy, plombage and thoracoplasty, and their late complications. Thoracoplasty is deforming and often leads to kyphoscoliosis and restrictive pulmonary impairment. Patients may also occasionally manifest concomitant obstructive airways disease. These defects may be severe enough to contribute to cor pulmonale and respiratory failure. Plombage complications are caused by migration of the plomb and local compressive effect of the plomb. Plombs may erode through neighboring structures, become infected, compress the mediastinum or superior vena cava, or cause bronchopleural fistulas or paraffinoma.

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