Collapse Therapy for Tuberculosis

A 72-year-old woman who was being evaluated for medical clearance for an elective cholecystectomy was asymptomatic, except for biliary colic. She had had pulmonary tuberculosis (TB) 40 years earlier, for which she had undergone surgery on the right hemithorax-a fact borne out by a thoracotomy scar. An x-ray film of her chest, shown here, demonstrates numerous plastic balls in the right thoracic cavity. This is an example of collapse therapy for pulmonary TB, which was practiced years ago, before the availability of effective antituberculous medications. The principle of such therapy was to compress the cavity and prevent oxygen from entering, thereby killing the Mycobacterium tuberculosis bacterium (an obligate aerobe).

Initially, collapse therapy was achieved by creating an artificial pneumothorax on the involved side. Other forms included surgical insertion of plastic balls (as in this case) or polyethylene sponges between the pleura and the lung, thus preventing lung expansion. With the advent of chemotherapy, collapse therapy was gradually abandoned. Nevertheless, comments Dr Sonia Arunabh of Mineola, NY, you may occasionally encounter an elderly patient who received such treatment. The appearance of an x-ray study such as this one may cause confusion, particularly if the history of TB has not been elicited.