Fatal mediastinal compression as a late complication of surgical plombage.

Abstract

had been treated for extensive sputum positive pulmonary tuberculosis with a two stage thoracoplasty on the right, a phrenic nerve crush, and later plombage with a polystan pack on the left; she received three months' treatment with streptomycin and para-aminosalicylic acid.She was a lifelong non-smoker with a history of cough and sputum, increasing dyspnoea over five years, and very restricted exercise tolerance. Her forced expiratory volume in one second (FEV,) was 0 4 1 and forced vital capacity (FVC) was 0 5 1. Indirect laryngoscopy confirmed a left vocal cord paralysis and a chest radiograph showed a giant, rounded opacity in the left hemithorax (fig 1). Radiographs from 1982 and1986 showed the appearance to be unaltered. She developed stridor and, over the next week, superior vena caval obstruction and a fluctuant mass over the apex of the left lung posteriorly. Bronchoscopy confirmed the left vocal cord paralysis and external compression of the trachea, 10 cm below the vocal cords. Computed tomography showed a partially calcified, fluid filled cyst, 16 cm in diameter, displacing the aorta and mediastinal structures and compressing the trachea. There was no enhancement after contrast and the mediastinal vessels were not directly affected. Within the cyst there was an area of low attenuation, which was thought to be the original polystan pack. The 2nd, 3rd, 4th and 5th ribs were destroyed posteriorly. There was no hilar or mediastinal lymphadenopathy (fig 2).A percutaneous drain was inserted posteriorly and 2 litres of haemorrhagic fluid Figure I Chest radiographs of the patient at presentation: left-posteroanterior; right-lateral.

Foreign Glass Bodies in Pleura and Pancreas: Systematic Review for Entry Hypotheses and Treatment Options in an Unresolved Case

“…Subsequently, these balls were known to migrate from the pleural space into various locations, including the mediastinum, the chest wall muscles, and even the subcutaneous tissue. 9 , 13 , 14 A similar pathway of migration was observed in the case of an impaled 2.5×1.6 cm glass shard, which took over 9 months to migrate within the pleural cavity before eventually working its way out through the thoracic wall. 5 These cases illustrate that the glass fragments in our case could have migrated considerably over time in various directions, despite initially being tightly assembled in one location.…”

“…Decades ago, when surgical plombage was employed as a treatment for collapsing the lung in cases of tuberculosis, the pleural space was filled with methylmethacrylate (Lucite) balls, each measuring 2.5 cm. Subsequently, these balls were known to migrate from the pleural space into various locations, including the mediastinum, the chest wall muscles, and even the subcutaneous tissue 9,13,14 . A similar pathway of migration was observed in the case of an impaled 2.5×1.6 cm glass shard, which took over 9 months to migrate within the pleural cavity before eventually working its way out through the thoracic wall 5 .…”

Severe Tracheal Compression as a Late Complication of Plombage

“…3 Frank clinical infection of the plombe leading to empyema, breast abscess, life threatening hemoptysis, spinal paralysis, oil aspiration, pneumonia and bronchial fistulas have been reported together with malignant lymphomas as a result of prolonged exposure to the infected plombe and fatal mediastinal compression. 4 Fluid collection is known to occur in the plombe 5 and was indeed the mechanism in our case. However, the peculiarity of our case is the occurrence at 36 years post procedure, leading to a severe tracheal compression, an unreported complication of plombage.…”