Raja Shekar Jadav1* and Akshay Avula2
1Internal Medicine Resident, St. Barnabas Hospital, NY, USA
2Pulmonary and Critical Care Attending Physician, St. Barnabas Hospital, NY, USA
*Corresponding author: Raja Shekar Jadav, Internal Medicine Resident at St. Barnabas Hospital, NY, USA, Tel: +1510-386-5758; E-mail: Jadav.raja@gmail.com
Received: April 24, 2021; Accepted: April 30, 2021; Published: May 10, 2021
Citation: Jadav RS, Avula A, et al. Oleothorax: Pulmonary Plombage. Clin Image Case Rep J. 2021; 3(4): 160.
A 62-year-old man with a history of hypertension and symptomatic bradycardia requiring a permanent pacemaker came in with worsening shortness of breath associated with decreased exercise tolerance and orthopnea. The examination was remarkable for pan systolic murmur at the apex, jugular venous distention, and decreased breath sounds in the right lung base. Chest radiograph (Figure 1) revealed cardiomegaly and a pleural-based rounded mass in the right pleural space inferiorly. Computed tomography (Figure 2) showed a loculated cystic mass (label A) (13 x 9 x 10 cm) measuring slightly above water density and apical bullae. An echocardiogram revealed severe left atrial and left ventricular dilation with an ejection fraction of 55% and prolapse of the anterior leaflet of the mitral valve (MV) with severe mitral regurgitation (MR). He was started on intravenous loop diuretics for congestive heart failure due to MR with improvement in symptoms. Later he underwent Mitra-Clip placement with improvement in MV function.
The loculated cystic mass in the lung was found to be Pulmonary Plombage which was placed in 1993 due to recurrent pneumothorax. Plombage (extra-pleural pneumonolysis) is a surgical treatment method used to treat cavitary lesions of the lung in patients with pulmonary tuberculosis (TB) during 1930-50s before the introduction of anti-TB chemotherapy by creating a cavity surgically under the ribs in the chest wall and filling the space with inert material [1]. The materials used in this procedure are acrylic balls, fat, wax, rubber, and mineral oil (oleothorax), where the latter was used in our case.
Rarely, Plombage is used to seal a large bronchopleural fistula that causes refractory pneumothorax, with only one reported case in the literature [2]. We present another case of Pulmonary Plombage used to treat refractory pneumothorax. Plombage of the pleural cavity connecting to the pleural space can be effective in treating refractory pneumothorax.
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