대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Chest Wall Tuberculosis

Radiologic Findings

CT scans of the upper mass show a well-defined, soft tissue density (HU 50) mass with minimal peripheral rim enhancement at the anterior chest wall. Small calcified nodule (Ghon’s focus) is shown in RLL superior segment. Bone erosion and expansile lesions at sternum are also noted. CT scans of the lower lesion show a dense nonenhancing high attenuation mass (HU 150) with internal flecks of calcification. Transverse sonograms over the anterior chest wall show two well-defined masses with different echo. Upper mass had intermediate echo and lower mass had low echo with internal nodular echoic foci suggesting calcifications.

Incision & drainage for upper mass and excisional biopsy for lower mass were done. Tuberculosis was confirmed at the two masses. This case well disclosed the serial change of TB abscess during several years on CT and ultrasonography.

Brief Review

Tuberculosis of the chest wall constitues 1% to 5% of all cases of musculoskeletal TB and represents between 1% and 2% of TB overall.

Tuberculous abscess of the chest wall can involve the sterum, costochondral junctions, rib shafts, costovertebral joints and the vertebrae. Multiplicity of the chest wall lesions seen in half the cases could be the result of a suppressed immunological response by host tissue. Destruction of bone adjacent to TB abscess though a common finding, is not always seen. It can take the form of disruption of the cortical margin or of an osterolyitc lesion, which could be expansile in nature.

Erosion of bone in TB results from pressure necrosis by granulation tissue and also by the direct action of invading organisms. Extensive destruction of bone can often raise a differential of neoplastic lesion. However, necrosis even if present in such lesion is unlikely to simulate the appearance of tuberculous caseous collections.

References

1. Morris BS, Maheshwari M, Chalwa A. Chest wall tuberculosis: a review of CT appearances. The British Journal of Radiology 2004;77:449-457.

2. Lee G, Im JG, Kim JS, Kang HS, Han MC. Tuberculosis of the ribs: CT appearance. J Comput Assist Tomogr 1993;17:363-366.

Keywords

Chest wall, Infection, Bacterial infection, Tuberculosis,