CHEST WALL TUBERCULOSIS: A SURGICAL OR A MEDICAL ENTITY

Abstract

Abstract

Introduction: Extrapulmonary tuberculosis (TB) constitutes 15%–20% of TB cases. Chest wall TB is a common cause of destructive rib lesions and often diagnosed with delay. Recurrence rate following medical treatment as a single mode of therapy is high. The aim of this study was to assess the approach to chest wall tuberculosis in six cases presenting with a chest wall mass or fistula in the northeast of Iran during a three-year period. 

Methods: This case series was carried out during a period of three years, between 2003 and 2006. Diagnosis of chest wall TB was established by the symptoms and signs of the patients, previous history of TB, location of the chest wall lesion, the results of aspirates, chest x-rays, biopsy and culture results, and computed topography (CT) scan of the lung. The effects of anti-TB regimens and surgery as parts of diagnosis or treatment were noticed. 

Results: Among the patients, 83.3% were originally from the southeast region of Iran. There was a positive history of lung TB in 33.3% of cases, one having concomitant active lung TB under a four-drug anti-TB therapy. A cold abscess in 50% and a chest wall fistula in 16.6% of cases were the presenting signs and symptoms. All results of the aspirates for acid-fast bacilli (AFB) smear were negative. Culture result was positive only in one patient after 40 days. The definite diagnosis was based on the pathologic results of the surgical biopsy in all cases. 

Conclusion: Surgery is the crucial part of diagnosis and treatment in cases of chest wall tuberculosis and should be accompanied by a period of treatment through anti-TB drugs.