Isolated tuberculous abscess of the chest wall simulates pyogenic abscess/chondrosarcoma - a case report

Abstract

Introduction. Chest wall tuberculosis is an uncommon manifestation, accounting for 1-2% of musculoskeletal and extrapulmonary tuberculosis cases. The pathophysiology involves hematogenous spread, direct extension from chest wall lymphadenitis, or spread from pulmonary or pleural diseases. Diagnosis is challenging, especially in immunocompromised individuals where TB can mimic various illnesses. Case presentation. A 50-year-old female presented with a painful swelling on the right lower lateral chest over the 9th rib. Clinical examination revealed a warm, painful, enlarging chest swelling with defined borders. Imaging studies (Radiograph, Ultrasonography, CT, and MRI) demonstrated a hypodense collection with suspicious soft tissue density, bony erosion, and involvement of adjacent structures. Conclusion. Primary TB of the chest wall is uncommon, often resembling tumors or pyogenic abscesses. Chest wall TB may affect various structures, and imaging plays a crucial role in diagnosis. Multidetector CT offers superior spatial resolution, aiding in assessing anatomical origin and response to therapy. The recommended treatment includes a six-month ATT regimen, with surgical interventions if necessary.