Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Chest Wall Tuberculosis: Clinical Features and Treatment Outcomes

  • Kim, Young Joo (Department of Internal Medicine and Respiratory Center, Kyungpook National University School of Medicine) ;
  • Jeon, Hee Jung (Department of Internal Medicine and Respiratory Center, Kyungpook National University School of Medicine) ;
  • Kim, Chang Ho (Department of Internal Medicine and Respiratory Center, Kyungpook National University School of Medicine) ;
  • Park, Jae Yong (Department of Internal Medicine and Respiratory Center, Kyungpook National University School of Medicine) ;
  • Jung, Tae Hoon (Department of Internal Medicine and Respiratory Center, Kyungpook National University School of Medicine) ;
  • Lee, Eung Bae (Department of Thoracic Surgery, Kyungpook National University School of Medicine) ;
  • Park, Tae In (Department of Pathology, Kyungpook National University School of Medicine) ;
  • Jeon, Kyung Nyeo (Department of Radiology, Gyeongsang National University School of Medicine) ;
  • Jung, Chi Young (Department of Internal Medicine, Fatima Hospital) ;
  • Cha, Seung Ick (Department of Internal Medicine and Respiratory Center, Kyungpook National University School of Medicine)
  • Received : 2006.07.24
  • Accepted : 2006.08.16
  • Published : 2009.10.30
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Abstract

Background: A diagnosis and treatment of chest wall tuberculosis (CWTB) is both difficult and controversial. The aim of this study was to collect information on the optimal treatment for CWTB. Methods: The clinical features, radiographic findings, and treatment outcomes of 26 patients, who underwent surgery and were diagnosed histopathologically, were retrospectively analyzed. Results: The most common presenting symptom was a palpable mass found in 24 patients (92.3%). In all patients, CT revealed a soft tissue mass that was accompanied by a central low density, with or without peripheral rim enhancement. The sensitivity and specificity of the bone scintigram for bone involvement were 87.5% and 100%, respectively. CWTB was diagnosed preoperatively by aspiration cytology and smear for acid-fast bacilli in five out of 11 patients. Twenty-three patients (88.5%) underwent a radical excision and three underwent incision/drainage or an incisional biopsy. The duration of antituberculous medication was 7.5${\pm}$3.98 months with a follow-up period of 28.2${\pm}$26.74 months. Among the 20 patients who completed their treatment, nine received chemotherapy for six months or less and 11 received chemotherapy for nine months or more. Two patients had a recurrence four and seven months after starting their medication. Conclusion: A 6 month regimen may be appropriate for CWTB patients who have undergone a complete excision.

Keywords

References

  1. Faure E, Souilamas R, Riquet M, Chehab A, Le Pimpec-Barthes F, Manac'h D, et al. Cold abscess of the chest wall: a surgical entity? Ann Thorac Surg 1998;66:1174-8 https://doi.org/10.1016/S0003-4975(98)00770-X
  2. Morris BS, Maheshwari M, Chalwa A. Chest wall tuberculosis: a review of CT appearances. Br J Radiol 2004;77:449-57 https://doi.org/10.1259/bjr/82634045
  3. Hulnick DH, Naidich DP, McCauley DI. Pleural tuberculosis evaluated by computed tomography. Radiology 1983;149:759-65 https://doi.org/10.1148/radiology.149.3.6647852
  4. Gayler BW, Donner MW. Radiographic changes of the ribs. Am J Med Sci 1967;253:586-619
  5. Mathlouthi A, Ben M'Rad S, Merai S, Friaa T, Mestiri I, Ben Miled K, et al. Tuberculosis of the thoracic wall: presentation of 4 personal cases and review of the literature. Rev Pneumol Clin 1998;54:182-6
  6. Eid A, Chaudry N, el-Ghoroury M, Hawasli A, Salot WL, Khatib R. Multifocal musculoskeletal cystic tuberculosis without systemic manifestations. Scand J Infect Dis 1994;26:761-4 https://doi.org/10.3109/00365549409008649
  7. Garcia S, Combalia A, Serra A, Segur JM, Ramon R. Unusual locations of osteoarticular tuberculosis. Arch Orthop Trauma Surg 1997;116:321-3 https://doi.org/10.1007/BF00433981
  8. Chang DS, Rafii M, McGuinness G, Jagirdar JS. Primary multifocal tuberculous osteomyelitis with involvement of the ribs. Skeletal Radiol 1998;27:641-5 https://doi.org/10.1007/s002560050451
  9. Martini M, Ouahes M. Bone and joint tuberculosis: a review of 652 cases. Orthopedics 1988;11:861-6
  10. Tatelman M, Drouillard EJ. Tuberculosis of the ribs. Am J Roentgenol Radium Ther Nucl Med 1953;70:923-35
  11. Paik HC, Chung KY, Kang JH, Maeng DH. Surgical treatment of tuberculous cold abscess of the chest wall. Yonsei Med J 2002;43:309-14 https://doi.org/10.3349/ymj.2002.43.3.309
  12. Hsu HS, Wang LS, Wu YC, Fahn HJ, Huang MH. Management of primary chest wall tuberculosis. Scand J Thorac Cardiovasc Surg 1995;29:119-23 https://doi.org/10.3109/14017439509107217
  13. Khalil A, Le Breton C, Tassart M, Korzec J, Bigot J, Carette M. Utility of CT scan for the diagnosis of chest wall tuberculosis. Eur Radiol 1999;9:1638-42 https://doi.org/10.1007/s003300050900
  14. Ward AS. Superficial abscess formation: an unusual presenting feature of tuberculosis. Br J Surg 1971;58:540-3 https://doi.org/10.1002/bjs.1800580719
  15. Chen CH, Shih JF, Wang LS, Perng RP. Tuberculous subcutaneous abscess: an analysis of seven cases. Tuber Lung Dis 1996;77:184-7 https://doi.org/10.1016/S0962-8479(96)90036-2
  16. Blunt SB, Harries MG. Discrete pleural masses without effusion in a young man: an unusual presentation of tuberculosis. Thorax 1989;44:436-7 https://doi.org/10.1136/thx.44.5.436
  17. Chang JH, Kim SK, Lee WY. Diagnostic issues in tuberculosis of the ribs with a review of 12 surgically proven cases. Respirology 1999;4:249-53 https://doi.org/10.1046/j.1440-1843.1999.00183.x
  18. Dutt AK, Moers D, Stead WW. Short-course chemotherapy for extrapulmonary tuberculosis: nine years' experience. Ann Intern Med 1986;104:7-12 https://doi.org/10.7326/0003-4819-104-1-7
  19. Brown RB, Trenton J. Chronic abscesses and sinuses of the chest wall:the treatment of costal chondritis and sternal osteomyelitis. Ann Surg 1952;135:44-51 https://doi.org/10.1097/00000658-195201000-00006
  20. Hopewell P, Cynamon M, Starke J, Iseman M, O'Brien R. Evaluation of new anti-infective drugs for the treatment and prevention of tuberculosis. Clin Infect Dis 1992;15 Suppl 1:S282-95 https://doi.org/10.1093/clind/15.Supplement_1.S282

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