Plombage

This bizarre chest X-ray shows the classic appearance following treatment with a now-obsolete procedure known as plombage or, to give it its correct medical description, ‘extrapleural pneumonolysis’. Prior to effective anti-tuberculous drugs, this was used to force the infected upper lobe (TB loves the upper lobes) to collapse, the logic being that this would speed up the healing process. Apparently it was reasonably effective in many patients. The inert material used to compress the affected upper lobe varied but frequently involved inserting balls of Lucite (a translucent plastic) or, in some cases, actual ping-pong balls between the pleura and ribs. In this example, from an 80 year old woman (all of these patients will be elderly) you can see multiple balls, all the same size, in the upper left hemithorax. Another clue to the history of previous TB is the calcified mediastinal and hilar lymph nodes, some of which are indicated by the arrows.