This patient underwent thoracic surgery for tuberculosis 50 years ago. The operation performed was a thoracoplasty. The upper 8 ribs on the right were removed. The rationale behind this
therapy was to collapse the underlying infected lung. Other procedures that have been used to achieve the same effect were artificial pneumothorax (often repeated or 'refilled'). Phrenicolysis (crushing or division of the phrenic
nerve), scalenectomy (division of the scalene muscles) and plombage (the extrapleural insertion of fat, soft paraffin wax, sponges or lucite spheres). Collapse therapy ended with introduction of effective chemotherapeutic agents in the
This patient was noted to tachypnoeic and cyanosed at the end of a minor surgical procedure performed under a general anaesthetic administered via a laryngeal mask. Gastrointestinal contents were
noted by the anaesthetist in the oropharynx. Clinical examination revealed reduced air entry throughout the left lung fields with bronchial breathing and widespread crepitations. This x-ray was taken 4 hours post
operation and shows extensive consolidation consistent with an aspiration pneumonitis.
This 85 year old lady was admitted for elective hip surgery. No significant pathology was identified by the house officer during her clerking and a 'routine' chest x-ray was requested. The
radiologist commented on a soft tissue mediastinal shadow. Returning to examine the patient a multinodular goitre with significant retrosternal extension was apparent. The patient was both clinically and biochemically euthyroid. The
goitre was asymptomatic, was causing no tracheal compression and no treatment was required.
This 89 year old lady has previously undergone wide excision and skin grafting for 4.6 mm superficial spreading melanoma of the lower leg. Two years after her surgery she presented with increasing
breathlessness and weight loss. The chest x-ray showed multiple bilateral lung lesion consistent with metastatic disease. The patient died within weeks