Complete Resection is Mandatory for Tubercular Cold Abscess of the Chest Wall

Abstract

Background. Cold abscess of the chest wall is a rare disease and few literature reports detail any treatment experience with a limited patient number. Hence, an optimal treatment plan remains controversial.

Tuberculous Empyema Presenting as a Persistent Chest Wall Mass: Case Report

“…Surgical removal of all diseased tissue, including bones and cartilage, is a safe approach, rarely complicated by spread of the infection. 2,32 The rate of operative mortality is around 5%. 13 Recurrence of infection is associated with insufficient removal of infected ribs or pleura and can occur up to 10 years after surgery, thus these patients need to be followed carefully for years.…”

“…1 Abscesses of the chest wall are found in less than 10% of cases involving musculoskeletal tuberculosis. 2,3 Abscess formation is driven by chronic inflammation of the pleural space, initially causing an empyema, which triggers development of a bronchopleural fistula allowing exudative material to enter the chest wall. The result is empyema necessitatis, a rare complication characterized by the dissection of purulent material through the soft tissues and eventually involving the skin.…”

“…38 Most experts suggest between 6 months to a year of anti-tuberculosis drug therapy. 2,35 If the infection has spread to the ribs (primary tuberculotic osteomyelitis) resection followed by a year of anti-tuberculosis drug therapy has been recommended. 39 …”

Two Rare Cases Involving the Spread of Tuberculosis: A Tuberculous Abscess of the Chest Wall Invading the Liver by Way of the Diaphragm

“…This is because multifocal TB has a high recurrence rate and the treated area can become infected (6)(7)(8). Finally, it is extremely important to eliminate any residual space and spray an anti-tuberculosis medication (INH or streptomycin) onto the surgically treated regions to prevent recurrence of TB and wound infection (2,7,9,10).…”

“…Tuberculous abscess of the chest wall (TACW) accounts for <10% of musculoskeletal TB cases, which represent 1-2% of all TB cases (1,2), and is thus rarely seen in clinical settings. However, TB which invades the liver is an even rarer event (3).…”