Management of Primary Chest wall Tuberculosis

Abstract

Primary tuberculosis of the chest wall is rare and its clinical presentation may resemble pyogenic abscess or tumour. The diagnosis is difficult, since smears or cultures of aspirate frequently fail to show tubercle bacilli. Seven cases of primary chest-wall tuberculosis treated between 1973 and 1992 are described. All presented with a progressively enlarging mass. The diagnosis was based on bacteriologic and histologic findings, but definitive diagnosis was obtained before treatment in only two cases. Satisfactory results were obtained with surgical debridement and specific chemotherapy in six cases and with chemotherapy alone in one case. From this limited experience, we suggest that primary chest-wall tuberculosis should initially be treated with a combination regimen of antituberculous chemotherapy, which should take more than 9 months. If the lesion progressively enlarges or secondary infection occurs, however, adequate surgical debridement is also required.

Tuberculous Abscess of the Chest Wall

“…Chen and coworkers successfully treated 3 patients with current antituberculous drugs, and reported no need for surgical procedures (7). According to Kaufmann, resection of a part of the rib is necessary, even it is macroscopically normal, because the origin of abscess is deeper (10). We observed completed remission with 12 months of antituberculous treatment.…”

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

“…The preoperative diagnosis of chest wall cold abscess has been known to be difficult [6]. Although many authors recommend performing a needle aspiration of the lesion to establish diagnosis, the procedure enables to establish a definite diagnosis in only one-third of the cases [4].…”

Sternal tuberculous osteomyelitis: a series of four cases

“…Clinical response precedes radiographic response, and the pain often resolves anywhere from two to six months before radiographic findings. 13 Many authors report surgical debridement to be essential to prevent recurrence or formation of a draining sinus. 18,19 They believe early drainage and complete debridement of necrotic material, which may include sternectomy, concomitant with ATT should be the mainstay of treatment; however, there are no formally defined surgical indications in the literature.…”

“…A three phase bone scan has high sensitivity and specificity for osteomyelitis, but gives less anatomic detail and does not indicate the cause of infection. 8,12,13 Gallium scans can be useful in showing other involved organs, but are also nonspecific with regard to the cause of infection and extent of damage. 14 A needle aspiration or excisional biopsy is mandatory for histopathological diagnosis of sternal osteomyelitis, because radiological findings cannot differentiate the cause of osteomyelitis, and sometimes may even appear neoplastic.…”

“…7,17 According to various published regimens, treatment can be continued up to 1.5 years after the first signs of clinical response, which can be seen in the first two to six months for sternal TB disease. These regimens consist of combinations of rifampicin, isoniazid, pyrazinamide and ethambutol for the first two to four months, followed by maintenance therapy with isoniazid and rifampicin, ethambutol for next 3m and isoniazid and rifampicin for next 1 yr. 3,9,13,17 Variations in regimens depend on clinical response, side effects, and culture and sensitivity results. Clinical response precedes radiographic response, and the pain often resolves anywhere from two to six months before radiographic findings.…”