Wednesday, 2 September 2015

xrayoftheweek 35: which procedure has been performed?

This week's #xrayoftheweek is this chest x-ray - which procedure has this person had in the past and why?

There is a deformity of the right upper rib cage - this is a thoracoplasty. This was a commonly performed procedure for the treatment of tuberculosis. Tuberculosis preferentially involves the upper lobes and in order to inactivate the infection and starve it of oxygen, the upper ribs were resected in order to collapse the rib cage. Variations of the procedure existed, with varying amounts of the thoracic wall resected or retained. We now see this in patients having x-rays for other reasons as the thoracoplasty itself rarely causes symptoms decades later. This CT image also shows the same findings, and for the eagle-eyed, also confirms the hiatus hernia: