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Thoracoplasty and Apicolysis
Jeffrey P. Kanne, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Extrapleural pneumonolysis:Plombage, oleothorax
              • Extrapleural apicolysis:Pleural tent, parietal pleurolysis
            • Definitions

              • Collapse therapy
                • Surgical procedures designed to collapse upper lobe cavitary tuberculosis; used in mid 20th century before effective antituberculous drug therapy
                • Oleothorax: Extrapleural injection of mineral/vegetable oils or paraffin wax
              • Thoracoplasty: Surgical rib removal to approximate chest wall, collapse lung, or obliterate pleural space
                • Alexander procedure: Rib resection and deformation of chest wall
                • Schede procedure: Expansion of extrapleural space with tissue implants
              • Extrapleural apicolysis (pleural tent): Performed to reduce apical pleural dead space after upper lobectomy
                • Apical parietal pleura pulled off chest wall, creation of extrapleural space, reduced intrapleural space
              • Phrenoplasty: Division of diaphragmatic-pericardial attachments to allow hemidiaphragm to rise in hemithorax and reduce pleural dead space

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Image Interpretation Pearls

                                Selected References

                                1. Tezel CS et al: Plombage thoracoplasty with Lucite balls. Ann Thorac Surg. 79(3):1063, 2005
                                2. Brunelli A et al: Pleural tent after upper lobectomy: a randomized study of efficacy and duration of effect. Ann Thorac Surg. 74(6):1958-62, 2002
                                3. Weissberg D et al: Late complications of collapse therapy for pulmonary tuberculosis. Chest. 120(3):847-51, 2001
                                4. Uchida T et al: Developing bronchial fistulas as a late complication of extraperiosteal plombage. Jpn J Thorac Cardiovasc Surg. 47(5):214-7, 1999
                                5. Jouveshomme S et al: Preliminary results of collapse therapy with plombage for pulmonary disease caused by multidrug-resistant mycobacteria. Am J Respir Crit Care Med. 157(5 Pt 1):1609-15, 1998
                                6. Ibarra-Perez C et al: More on thoracic neoplasms related to Lucite sphere plombage. Chest. 107(2):581-2, 1995
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Top Differential Diagnoses

                                      • Clinical Issues

                                        • Diagnostic Checklist

                                          TERMINOLOGY

                                          • Synonyms

                                            • Extrapleural pneumonolysis:Plombage, oleothorax
                                            • Extrapleural apicolysis:Pleural tent, parietal pleurolysis
                                          • Definitions

                                            • Collapse therapy
                                              • Surgical procedures designed to collapse upper lobe cavitary tuberculosis; used in mid 20th century before effective antituberculous drug therapy
                                              • Oleothorax: Extrapleural injection of mineral/vegetable oils or paraffin wax
                                            • Thoracoplasty: Surgical rib removal to approximate chest wall, collapse lung, or obliterate pleural space
                                              • Alexander procedure: Rib resection and deformation of chest wall
                                              • Schede procedure: Expansion of extrapleural space with tissue implants
                                            • Extrapleural apicolysis (pleural tent): Performed to reduce apical pleural dead space after upper lobectomy
                                              • Apical parietal pleura pulled off chest wall, creation of extrapleural space, reduced intrapleural space
                                            • Phrenoplasty: Division of diaphragmatic-pericardial attachments to allow hemidiaphragm to rise in hemithorax and reduce pleural dead space

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • CT Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Demographics

                                                        • Natural History & Prognosis

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Tezel CS et al: Plombage thoracoplasty with Lucite balls. Ann Thorac Surg. 79(3):1063, 2005
                                                              2. Brunelli A et al: Pleural tent after upper lobectomy: a randomized study of efficacy and duration of effect. Ann Thorac Surg. 74(6):1958-62, 2002
                                                              3. Weissberg D et al: Late complications of collapse therapy for pulmonary tuberculosis. Chest. 120(3):847-51, 2001
                                                              4. Uchida T et al: Developing bronchial fistulas as a late complication of extraperiosteal plombage. Jpn J Thorac Cardiovasc Surg. 47(5):214-7, 1999
                                                              5. Jouveshomme S et al: Preliminary results of collapse therapy with plombage for pulmonary disease caused by multidrug-resistant mycobacteria. Am J Respir Crit Care Med. 157(5 Pt 1):1609-15, 1998
                                                              6. Ibarra-Perez C et al: More on thoracic neoplasms related to Lucite sphere plombage. Chest. 107(2):581-2, 1995