RESUMO
INTRODUCTION: In the 1930-50s, before the introduction of antimicrobial drugs and development of techniques of pulmonary resssection, collapse therapy was the mainstream of treatment for cavitary pulmonary tuberculosis. The methods to achieve the collapse included artificial pneumothorax with air refills, phrenic nerve crush, thoracoplasty and extrapleural plombage. The plombage involves creating a cavity surgically under the ribs in the upper chest wall and filling the space with inert material, such fat, paraffin wax, rubber ballons, oil and methyl-methacrylate (Lucite) balls. The theory behind Plombage treatment is that collapse of the lung promote de healing process and limit the spread of tuberculous infection to other areas of the lung. However, with time, the presence of these materials for a prolonged period of time resulted in complications, such as erosion of major vessels, respiratory insufficiency, infection and migration. METHODS: We present a clinical case of one patient presented with a late complication of lucite ball plombage after 55 years. RESULTS: An 78-year-old man with a history of pulmonary tuberculosis treated with plombage in 1962, ischemic heart disease, hypertension and diabetes mellitus, was admitted to hospital for axillary swelling and pleurocutaneous fistula. The x-ray of the chest and computed tomography showed the apex of the left hemithorax filled with multiple lucite balls, each approximately 2,5cm in diameter, and extrusion of a ball into the axillary fistuluous tract. In this context, the patient complied with multiple antibiotic regimens without success. So, the patient was submitted to surgical extraction of 21 lucite balls, pleurocutaneous drainage and thoracoplasty (7 ribs and the tip of the scapula was remove). The cultures turned out to be negative and the patient made an uneventful recovery with discharge on the 19th postoperative day. Pathologic examination revealed active chronic inflammatory process and negative microorganism screening. CONCLUSION: Despite the rapid decline in collapse therapy since the appearance of antitubercular chemotherapy, there are still such elderly patients who remain asymptomatic while carrying residual plombage material. There is no need for routine ablation of any this material, however if any foreign material becames a source of complication should be extracted without delay. As the number of living patients treated by plombage is attenuating rapidly, fewer and fewer will be seen in the future, and no one is likely to accumulate considerable experience with this problem.