Oleothorax: An Ultrasound Sign of an Old Practice.

INTRODUCTION: The high morbidity and mortality of tuberculosis has led to the development of numerous therapeutic interventions during the pre-antibiotic era. In 1894, Forlanini proposed the technique of collapse therapy, using spontaneous pneumothorax. In 1926, Bernou developed the oleothorax technique to induce an iatrogenic collapse of the lung through the instillation of oil into the pleural cavity, which was subsequently removed. Nowadays, there are few patients that still represent a living testimony of this historic technique and have been described through traditional radiology. CASE PRESENTATION: We report the case of a patient with evidence of a right oleothorax that was investigated not only with traditional radiology but also with the use of chest ultrasonography. Ultrasounds were able to show peculiar characteristics of the oleothorax, including its particular echogenicity, the rigidity and static nature of the collection, the presence of peripheral calcifications, and the negative impact of the collection on diaphragmatic mobility and excursion. CONCLUSION: To our knowledge, this is the first report of an ultrasound description of oleothorax. We have observed that ultrasound examination, in cases of basal oleothorax, is able to add information regarding its radiological appearance and physiopathological implications on ventilatory mechanics and diaphragmatic distress.

Oleothorax: A Historic Chest Radiograph Finding.

Even though tuberculosis (TB) is an extremely old disease, proper effective treatment for the condition became available only around 1944, with the discovery of streptomycin's effect on Mycobacterium tuberculosis. Until then, surgical approaches had been among some of the treatments employed, which were dropped with the progressive development of antimycobacterial agents. We present a case of an 83-year-old woman, with a history of pulmonary tuberculosis (PT) at the age of 15 years, presenting with a seven-day history of cough, dark sputum, dyspnea, and pleuritic chest pain. She was submitted to a chest radiograph. The exam revealed a large oval calcified mass on the left apex, compatible with oleothorax. Oleothorax should be included in the differential diagnosis of large calcified thoracic masses in older patients.

Complication of antiquated tuberculosis treatment.

In the early 20th century, the rapid spread of tuberculosis (TB) invited novel therapies for treatment. A surgical procedure known as plombage was one such method where lobes were forced to collapse by placing an inert object such as mineral oil, paraffin wax, gauze or Lucite (methyl methacylate) balls. The collapse would lead to isolation of TB infection and decrease aeration of the affected lung. Removal of these objects had initially been, usually after 24 months, however this fell out of favor after the patient had recovered without commonly seen late complications. Decades later, reports have been made illustrating complications such as migration and infection of the plombe as well as expanding oleothorax.