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8/14/2019 LUCITE EXTRAPERIOSTEAL PLOMBAGE
http://slidepdf.com/reader/full/lucite-extraperiosteal-plombage 1/4
V O L . ioo , No . 3
59 3
LUC ITE EXTRAPER IO STEAL PLOM BAGE*
ROENTGENOLOGIC REV iEW O F LA TE COM PL iCAT ION S
By CHAR LES E . SE IBERT , M .D ., an d JOSEPH TABRISKY, M.D.
D EN VE R , C OL OR AD O
S INCE 1946 ,58 ho llow lu cite b a lls have
b een u tilized in ex trap e rio s tea l p lom -
bage fo r co llapse the rapy o f pu lm onary
tu be rcu lo sis . A t the p resen t tim e , the in -
d ica tion s fo r p lom bage are ra the r s tring en t
becau se o f ad vances in chem o the rap y . A t
the N a tion al Jew ish H osp ita l, D enve r,
C olorado , patien ts are con sid ered for
p lom bag e o n ly w h en they sa tis fy all o f th e
fo llow in g condition s: (i) The d isea se ha s
been re sis tan t to a ll d rug s and the pa tien t
h as p ersis ten tly po sitive spu tum ; (2) upp e r
lo be cav ita tio n is p resen t and s tra teg ica lly
situ ated to a llow ob stru c tio n of the b ron-
ch ia l com m un ica tion by p lom bag e; and
(3) pu lm on ary re se rv e is so sign ifican tly
im pa ired tha t resec tion al the rapy w ou ld re -
su lt in a “p u lm ona ry c rip p le .” P lom bage
w ou ld pre se rve the m ax im a l am oun t o f
pu lm on ary func tion com pa tib le w ith co n-
tro l o f the d is ea se .
D esp ite the reduc tion in the num ber o f
lu cite p lom bag e ope ratio ns pe rfo rm ed ,
the re rem ain s a la rge pa tien t g roup w ho
have u nd erg on e th is typ e o f co llapse the r-
ap y an d o ccasion ally the rad io log is t w ill
be co nfron ted w ith the p ro b lem of d iag -
no sing com p lic at ion s o f the p ro cedu re .
SURG ICAL PROCEDURE
In ex traper ios tea l luc ite p lom bag e as
desc rib ed by W ilson et a l.,8 th e n um ber and
len g th o f rib s strip ped o f the ir pe rio steum
is fash ion ed to co llapse a cav ita ry le sio n ,
but to leav e the surround ing m ore norm al
lu ng func tion a l. T h e p eriosteum is str ipped
from the und ersurfa ces o f th e se lec ted
r ib s . Th e luc ite sph ere s a re then p laced
sep ara tely o r w ith in a po lye thy lene sh ee t
in th e space fash ion ed (F ig . i). Extens ive
ap ico lysis is no t don e since th is w ou ld
p red isp ose to m igra tio n and eros io n of the
Fic . i. D iagram matic illu stra tio n o f ex trape rio s tea l
luc ite sphe re im plan ta tion .
lu c ite ba lls m ed ia lly , w h ich cou ld im p air
venous r etu rn by pres su re o n the m ed iastin al
ve ins .
PATHOLOG IC RE ACT IO N TO
LUCIT E IM PL ANTAT IO N
N orm ally , th e luc ite sph eres b ecom e
r ig id ly fix ed by a process o f hya lin iza tion
and fib rosis .6 ’7 In th e im m ed iate po s top er-
ativ e p eriod , the re is a cop io us exud ate
an d a ir-flu id leve ls are dem onstra ted
w ith in the p lom bage (F ig . 2) . This exud a tereso lve s w ith in sev e ra l w eeks as hy alin iz a -
tio n occur s (F ig . 3) . Fa ilu re o f a ir-flu id
levels to regre ss in the early p ha se in d ic a tes
tu bercu lous or nontub ercu lous in fec tion
o f the su rg ica l sp ace . R are ly , in the first
* From th e Departm ent of R ad io logy , Natio nal Jew ish H osp ita l, D enver , C olorado .
8/14/2019 LUCITE EXTRAPERIOSTEAL PLOMBAGE
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1”
.y-i
Fic . Sam e case as in F ig ure 4 , on e year la te r. T h e
patien t now has p osit ive sp u tum for tu bercu losis.
Low er b order o f p lom bage is seen bu lg in g dow n-
w a rd .
59 4 Charles E . S eib e rt and Joseph Tabrisk y J U L Y , 1967
11G . 2 . Early po sto perativ e roen tg eno gram revea lin g
the expected exuda te and air-flu id level .
few m onth s fo llow ing tile p rocedure , a
fo re ig n b od reac tion w ill d isso lve t i l e ou te r
f ib ro tic capsu le a rou nd the p lom bage .
L ATE COM PL ICAT ION S
I . R ED EV ELOPMENT OF FLU ID W ITH IN TH E
PLOMBAGE SPACE
Sagg in g of th e in fe rio r aspect o f th e
F ic. 3. N orm al f ib rosis an d hyalin iz atio n o ccu rring in
p lom bage sp ace i m onth afte r su rgery .
Fic. In fe rio r bo rde r of p lom bag e m arked on the
ro en tg en ogram s to dem ons tra te the pro gress ive
sag . T herapeu tic pn eum operitoneum is p resen t.
p lombag e i s a m an i fe st at io n of recurren t
flu id fo rm a tio n . Th e illu s tra tions show an
inc reasin g depend en t s ag o f the p lom bag e
sp ace over seve ra l yea rs (F igs. 4 an d 5). It
is ob v iou s t i la t the su rrou nd in g tissu e h as
8/14/2019 LUCITE EXTRAPERIOSTEAL PLOMBAGE
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8/14/2019 LUCITE EXTRAPERIOSTEAL PLOMBAGE
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59 6 C harles E . S eibe rt and Josep h T ab risky J U L Y , 1967
p leu ral em pyem a or in fec tio n o f the
p lom bage reg io n d ev elo ps w ith e ith er tu -
bercu lous or n on tub ercu lou s b acteria .’ If
th e rad io log is t can p o in t ou t th e p resence
o f em py em a from th e s ig ns d esc ribed , then
ser iou s sequ ela e m ay be avo ided by su r-
g ical m e thod s.
S UMMARY
The rad io log is t s till see s a num ber o f
luc ite p lom bage case s and can ro en tgen -
ograph ica lly d iagnose the late complica-
tio ns. L a te com p lica tion s are u sua lly re -
la ted to the d ev e lopm en t o f tub e rcu lou s
o r n on tub ercu lo us in fec tio n w ith in th e
p lom bage sp ace .
2. The in fec tion of the p lom bage reg ion
is cha rac te rized b y : (a ) deve lopm en t o f
fluid w ith in th e p lom bag e d em on stra ted
by e ithe r ch an ge in po sition o f the luc ite
balls or sagg in g of th e in fer ior asp ect o f th e
su rg ical space ; (b ) the e rosio n an d m igra -
tio n o f th e b alls from th e p lom bag e reg ion ;
and (c) fo rm ation o f b ron chop leu ra l or ex -
t rap leu ral fis tu lae .
Jo seph T abrisky , M .D .
1 8 4 5 High Street
D en ve r, C ol or ad o 80218
R E FE RE NCE S
I. D E5F OR GES , G ., GIBBoNs , G ., and STRIEDER , J.
w . T ubercu lous in fec tions com p lica t in g sub-
costa l p lom bage w ith luc ite spheres fo r co llapse
th e rapy of pu lm onary tubercu los is . 7.Thorac ic
Surg ., ‘954 , 28 , 63 6 -637 .
2 . D RES SLER , S . H ., BRONF IN , G. J., an d GROW , J.
B . Pu lm ona ry fu nc tion stud ies be fo re and afte r
ex trap leu ra l pneum onolys is w ith p lom bage . 7.
Thorac ic Surg ., 1 9 5 0 , 19 , 938-943 .
3. INADA , K., S A T O , A. , KIsHIM0T # {244 } , S ., a nd T A N A B E ,
G . Eva lu atio n of ex trap leu ral p neum ono ly sis
w ith filling w ith p las tic ba lls . 7. Thorac ic Surg .,
1 9 5 4 , 27 , 503- 513 .
4. JOLY , H., T ULOU , P., T IRET , J., an d VILLEMIN , J.
Plom bage in su rg ica l trea tm en t o f pu lm onary
tubercu los is . 7. Tho rac ic Su rg ., 1957 ,34 , 36-48.
L U C A S , B . G . B ., and C L E L A N D , W. P . T ho ra co -
p la sty w ith p lom bag e: rev iew of early re su lts in
125 cases . Thorax, 1 9 5 0 , 5, 248-256.
6. WIL sON , D . A ., an d BAKER , H . Exper imen ta l
su rg ical pu lm onary co llapse . S urg ., G yn ec . &
Obs t . , 1946, 82 , 735-742 .
7. W I L S o N , D . A . E x trap leu ra l pn eum onolys is w ith
luc ite p lom bage . 7 . Thora cic S urg ., I948, 17 ,
111-122.
8. WIL SoN , N. J. , ARMADA , 0., VINDZBERG, W. V.,
and O’Brien, W. B. Extraperiosteal plombage
tho racop la sty : ope rativ e techn iq ue and re su lts
w ith i6 i ca se s w ith un ila te ra l su rg ica l p rob lem s.
7. Thorac ic Su rg ., 1956 ,32 , 797-8 19 .
9. YOUNG , F . H . E xtraper iostea l p lom bage in treat-
m en t o f p u lm onary tub ercu losis . Thorax , 1958 ,
13 , 13 0-135 .