Localized Collapse of the Lung by Means of an Extrapleural Balloon

The dangers of cavitation in pulmonary tuberculosis are well recognized and several different mechanical procedures have been devised for the collapse of these cavities. It is, likewise, well established that no one method of collapse is ideal for all cases and the method chosen in any instance will depend upon many factors, among which are the location and extent of the pathology. In general, the simplest procedure is the one to be selected, providing it can accomplish the desired result. It is not within the scope of this report to discuss the indications for the various types of collapse therapy or the types of cavitation which may occur. It will be sufficient to point out that among the factors to be considered are the position and size of the cavity, together with the duration and extent of the disease, the condition of the patient, and various economic factors. It not infrequently happens that the pathology is limited to a small area such as the apex of the lung where a large cavity may persist as a constant menace to the health of the patient. If the pleural space has been obliterated by adhesions, so that an artificial pneumothorax is no longer possible, an operative procedure may be indicated. However , if the pathology is limited to a comparatively small area of the lung, the radical thoracoplasty may appear to both the patient and the internist as being in severity, a form of treatment out of proportion to the disease. Furthermore, if the remainder of the lung is not involved, or if the condition of the contralateral lung cannot be exactly determined it may be desirable to obtain a localized collapse by operative means. Some of the operative procedures which have been used in attempting to obtain such a selective collapse may be briefly summarized: (i) Partial thoracoplasty may be carried out by using the same technic as for the radical thoracoplasty, except that portions of all the ribs are not resected. It has been well demonstrated that in the radical thoracoplasty the efficiency of the collapse depends largely on the dropping and rotation of the thoracic cage when portions of all of the ribs have been removed. A partial thoracoplasty is frequently