Percutaneous Drainage of Thoracic Wall Cold Abscess with Malecot’s Catheter -Indications and Pitfalls

Abstract

Chest wall cold abscess is a rare presentation. Tubercular localization in the thoracic cage is rare and difficult to diagnose, due to multiple clinical presentations with chest wall cold abscess being the commonest. Cold abscess of the chest wall must be treated more aggressively, and meticulous debridement and wide resection including involved bones and cartilages is required followed by coverage with local muscle or musculocutaneous flaps. Tube drainage under adequate ATT cover is a viable treatment option especially in patients not amenable to surgical intervention. Sinus formation after tube drainage reflects inadequate medical treatment. Small bore tubes should be used, which should be removed once radiological and clinical evidence of diseases resolution is obtained. If Malecot’s catheter is left for a long time in the cold abscess cavity, it get’s retained due to soft tissue in-growth from the collapsing cavity into the catheter tip and wings. The tissue in-growth and fibrosis can lead to complete integration of this foreign body into the tissues, which can only be removed through a surgical procedure. In such cases Malecot’s catheter is removed en-masse with a cuff of granulation tissue to ensure complete clearance of the foreign material.