Thorax Radiology, Acute Empyema of Pleurae; Plombage (english)

Complications and Differential Diagnosis

Wolfgang G. H. Schmitt - Buxbaum

Table of Contents



Abstract: Acute Pleural empyema; Oil/Paraffin plombage

Pleural emyema is a dangerous disease. There is a chance of controlling the situation if the alarm signs are well understood: 
 - Multi-sided localisation.

- Not homogenous empyema because of irregular mixed  cell-rich  / protein-rich content.
- The tenacity of the empyema: thereby, a completely atypical distribution of trapped air content. 
- The compression atelektasis with the corresponding subsequent infection threat of the lung-parenchyma. -

It is necessary to form a surgical team;The surgeon enriches us with his experience of mini-thoracotomy and pleuroscopy. The radiologist performs the decisive elements during the translation of the images in the situation as concerns the "situs.

Oleothorax, the pneumothorax-therapy and the thoracoplasty 
belong to the "collapse therapies”, long-forgotten types of tuberculosis treatment.

Plombage treatment was used in the second quarter of the 20th century.  Oil- or Paraffin-plombage may be summarized as "oleothorax.” In Europe paraffin was the preferred material; the preferred location was  "extrapleural”,  between the Fascia endothoracica and the Pleura parietalis.
Anamnesis and X-rays make the diagnosis very simple. The fatty material is – because of the period length-  not so inert, as hoped. The presentation deals with the variety of complications:

sterile or infected exsudat influx in the plombage, different forms of perforation ("Paraffinomata”). 
 Highlights as concerns the differential diagnosis are shown:
 Asbestosis, pleural Mesothelioma, Silicosis, thorax wall calcification, aspiration of contrast material.



76-80:  Paraffin plombage    and/or    oil plombage

81-85: Early and late complications 

86-90: Thoracopasty (combined with a dislocated  plombage)

91-95:  Pleural empyema

96-100: complication of the empyema. What are typical discoveries in pleural empyema ? 

101-105: highlights as concerns the differential diagnosis 

106-110: oncology, heterotopic thyroid, teratoma

111-115: Asbestosis, pleural Mesothelioma

116- 120 Silicosis; repeat the many signs of fibrothorax