Anterior chest wall tuberculous abscess: a case report

Musculoskeletal Tuberculosis of the Pectoralis With Bilateral Pleural Base Nodular Lesions: A Rare Report of Its Type in an Immunocompetent Female

Musculoskeletal tuberculosis is a rare infection caused by Mycobacterium tuberculosis. This type of extrapulmonary tuberculosis is mainly attributed to hematogenous infection or direct inoculation and is usually seen in immunocompromised individuals. Here, a case of musculoskeletal tuberculosis of the right pectoralis with bilateral pleural base nodular lesions in an immunocompetent female is presented. A challenging diagnosis was achieved through a detailed clinical examination, aspiration of the pus, and radiometric investigations. Management was done through antituberculous chemotherapy per the national guidelines. Further, a detailed literature review revealed that tuberculosis of the pectoralis with bilateral pleural base nodular lesions is never reported in an immunocompetent female.

Spontaneous Mediastinal Abscess and Sternal Cleft in the Medically Complex Neonate

Sternal cleft (SC) is a rare congenital anomaly, occurring with associated developmental anomalies or in isolation. Surgery to reconstruct the sternum is indicated to protect the visceral organs from trauma, to ensure healthy cardiopulmonary function and growth, and to reconstruct the anterior chest wall. Although infection recognized as a postoperative complication following chest wall reconstruction, spontaneous mediastinal infection is rare. To the authors' knowledge, there is only 1 reported case of spontaneous mediastinal infection with concomitant SC in the literature. Here, the authors present a unique case of a medically complicated infant with a SC who presented with a spontaneous mediastinal abscess.

Chest wall mass: what lies beneath?

CLINICAL INTRODUCTION

A 24-year-old Filipino man attended the ED with a 1-month history of a discrete swelling over his upper anterior chest wall that was rapidly increasing in size and tenderness. He denied any other symptoms. His medical history was unremarkable.Examination revealed a tender, 7 cm × 6 cm mass over the upper part of the sternum (figure 1). The surface was smooth, it was immobile, non-compressible and the overlying skin was normothermic but mildly erythematous. Cervical lymphadenopathy was present. His vital signs were normal.emermed;35/10/586/F1F1F1Figure 1Chest wall mass.

QUESTION

What is the most likely diagnosis?LipomaChondrosarcomaLymphoma Mycobacterium tuberculosis (TB).

Chest wall tuberculous ulcer: A rare complication of pulmonary tuberculosis

Tuberculous ulcer of the anterior chest wall as a result of direct extension from underlying pleural and pulmonary tuberculosis is a very rare entity. Its clinical presentation may resemble a tumor or abscess. Isolated chest wall tuberculous ulcer without bone involvement is even rarer. An illustrated case report is presented.

Tuberculous pyomyositis: a re-emerging entity of many faces

Tuberculosis (TB) has become a global concern due to its increasing incidence, particularly in immunocompromised patients, closely following the migratory patterns of populations. TB pyomyositis is a rare extrapulmonary manifestation of TB. Its clinical presentation varies and requires a high degree of suspicion for early diagnosis. We present three patients diagnosed with TB pyomyositis: a 46-year-old man with dermatomyositis (DM) and hepatitis B who presented with fever, muscle weakness, and an abscess at the right proximal arm; a 71-year-old immunocompetent male, with a past medical history of tuberculous lymphadenopathy in childhood, who presented with a 2-month history of fever and pain at the right thigh, and a 44-year-old woman with systemic lupus erythematosus (SLE) on prednisone and methotrexate who presented with skin eruption at her thighs mimicking lupus panniculitis. In all three patients, Mycobacterium tuberculosis was identified as the causative agent. The lack of specific signs, the false negative tuberculin skin test in some cases, and the unfamiliarity of many clinicians with this entity can cause diagnostic delays. Prompt diagnosis requires a high index of suspicion especially in immunocompromised patients with fever.

A chest wall pulsating mass

A 34-year-old HIV-positive man with intravenous drug addiction presented with a 2-week history of fever and a pulsatile presternal mass; 2 weeks prior he had suffered a traumatic sternal fracture. The CT scan showed a bulky abscess with presternal and retrosternal extension that contacted the heart (which explained its pulsatile effect) and pulmonary necrotising lesions. Drainage of the thoracic wall abscess was performed, and antibiotics (flucloxacillin plus gentamicin) were started on the presumption of staphylococcal bacteraemia given the patient's intravenous drug habit. Blood cultures and culture of the aspirated pus confirmed growth of methicillin-sensitive Staphylococcus aureus; transoesophageal echocardiography showed endocarditis of the tricuspid valve. We therefore assumed pulmonary septic embolisation from right-sided endocarditis and acute sternal osteomyelitis, and the patient was treated for 6 weeks with clinical resolution.

A Young Lady with a Swelling over the Back: A Rare Case of Tuberculosis

Musculoskeletal tuberculosis accounts for 1-2% of all types of tuberculosis. Tubercular abscess of the chest wall accounts for 1-5% of all cases of musculoskeletal tuberculosis. Herein, we report a case of tubercular abscess of the chest wall. The occurrence of caries rib and cold abscess of the chest wall with concomitant pulmonary tuberculosis, and tubercular lymphadenitis of neck and mediastinum has rarely been described in an immunocompetent individual. The rarity of our case lies in the fact that the patient was immunocompetent with cold abscess due to caries rib, with rare association of pulmonary tuberculosis and tubercular lymphadenitis of neck and mediastinum.

Management of gall bladder perforation evaluation on ultrasonography: report of six rare cases with review of literature

BACKGROUND

Perforation of the gall bladder with cholecystohepatic communication is a rare cause of liver abscess. We are reporting here six rare cases of gall bladder perforation with variable clinical presentations.

MATERIALS AND METHODS

Most patients presented with right hypochondrium pain and fever but two patients presented with only pain in the abdomen. Ultrasonography (USG) and Computed Tomography (CT) were used for diagnosis. The patients were also successfully treated.

RESULTS

There was a gall bladder perforation with cholecystohepatic communication, leading to liver abscess formation in most cases on USG and CT. The final diagnosis was confirmed on surgery.

CONCLUSION

The perforation of the gall bladder which leads to liver abscess is a rare complication of acute, chronic or empyema gall bladder. USG and CT scans are the most important diagnostic tool in diagnosing this rare complication. In the set up, where advanced options are not available, the only treatment of choice is the conservative one or surgery, according to the status of the patients.

Contribution of computed tomography guided percutaneous drainage of tuberculous cold abscesses adjunctive to pharmaceutical anti-tubercular treatment

PURPOSE

To determine the efficiency and safety of the percutaneous aspiration and drainage of rare touberculous cold abscesses under CT guidance.

MATERIALS AND METHODS

We retrospectively studied 63 cases of 44 patients, treated in our hospital during the last two years. They suffered from tuberculous infection complicated with tuberculous cold abscesses variously located. All these patients underwent percutaneous aspiration and drainage under CT imaging, following the trocar puncture technique. The catheter remained in place for about a week. A follow up CT scan was performed in all cases before the catheter removal. Some of the patients were under anti tuberculosis medication.

RESULTS

All the patients had a successful recovery from the abscesses. There were no major or minor complications observed. No recurrence occurred until today.

CONCLUSION

CT guided percutaneous aspiration and drainage of tuberculous cold abscesses is a safe, minimal invasive and effective method of treatment. Drainage and specific antituberculosis therapy leads to a satisfactory conclusion.

Pre-sternal mass with a congenital sternal defect: a rare presentation

Anterior chest wall and anterior mediastinal infections are very rare in children with no predisposing thoracic surgery. Congenital sternal defects occur as a result of incomplete ossification of the sternal bone, and show a wide range of severity. We present the case of a 15-month-old boy who presented to the A&E department with an anterior chest-wall mass. After investigation, it was found to be an infective mass, with extension into the anterior mediastinum, through a previously undiagnosed 5 mm congenital sternal defect identified peri-operatively. After antibiotic therapy and surgical management the patient made complete recovery with no recurrence or complications within 6 months of review.