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Chandanwale SS, Raj A, Singh M, Kundlia A. Sternoclavicular Tuberculosis: An Unusual Presentation. J Glob Infect Dis 2024; 16:33-35. [PMID: 38680750 PMCID: PMC11045152 DOI: 10.4103/jgid.jgid_64_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 05/01/2024] Open
Abstract
Extra pulmonary tuberculosis is on the rise worldwide, and younger patients, are females. And people from Asia and Africa are at high risk. Sternoclavicular TB is extremely rare, even in countries that have a high prevalence of TB. It can be in the absence of pulmonary TB. It has a varied clinical presentation. Painless chest wall swelling can be the presenting symptom of sternoclavicular diagnosis. Ultrasonography and high-resolution computed tomography can identify the nature of the lesion and the extent of bone involvement. Aspiration from the swelling or histopathology examination is mandatory for diagnosis. Caseous necrosis is diagnostic of TB. Detection of acid-fast bacilli in smears or tissue or molecular methods is required for definitive diagnosis. A high degree of clinical suspicion is required for early diagnosis. The treatment of thoracic TB is the subject of controversy. Anti-tubercular drugs are the mainstay of treatment. Surgical intervention is basically for flattening cold abscesses and removing infected tissue, including affected bones and cartilage.
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Affiliation(s)
| | - Akshi Raj
- Department of Pathology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Madhuri Singh
- Department of Pathology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Aakriti Kundlia
- Department of Pathology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
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Yan QH, Chi JY, Zhang L, Xue F, Cui J, Kong HL. Value of ultrasound guided biopsy combined with Xpert Mycobacterium tuberculosis/resistance to rifampin assay in the diagnosis of chest wall tuberculosis. World J Clin Cases 2023; 11:6698-6706. [PMID: 37901011 PMCID: PMC10600869 DOI: 10.12998/wjcc.v11.i28.6698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND The thoracic wall lesions, particularly chest wall tuberculosis, and chest wall tumors and other pyogenic wall and actinomycetes infections, almost always present as a diagnostic challenge. AIM To explore the value of ultrasound-guided biopsy combined with the Xpert Mycobacterium tuberculosis/resistance to rifampin (MTB/RIF) assay to diagnose chest wall tuberculosis. METHODS We performed a retrospective study of patients with chest wall lesions from March 2018 to March 2021. All patients received the ultrasound-guided biopsy for pathology examination, acid-fast Bacillus staining, mycobacterial culture, and Xpert MTB/RIF analysis. The sensitivity, specificity, and area under the curve (AUC) were calculated for these diagnostic tests, either individually or combined. Rifampicin resistance results were compared between the mycobacterial culture and the Xpert MTB/RIF assay. RESULTS In 31 patients with the chest wall lesion biopsy, 22 patients were diagnosed with chest wall tuberculosis. Of them, 3, 6, and 21 patients tested positive for mycobacterial culture, acid-fast stain, and Xpert MTB/RIF assay, respectively. The rifampicin resistance results of the 3 culture-positive patients were consistent with their Xpert MTB/RIF assay results. When considering the sensitivity, specificity, and AUC value, the Xpert MTB/RIF assay (95.5%, 88.9%, and 0.92, respectively) was a better choice than the acid-fast Bacillus stain (27.3%, 100.0%, and 0.64, respectively) and mycobacterial culture (13.6%, 100.0%, 0.57, respectively). No complications were reported during the procedure. CONCLUSION Ultrasound guided biopsy combined with Xpert MTB/RIF has high value in the diagnosis of chest wall tuberculosis, and can also detect rifampicin resistance.
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Affiliation(s)
- Qing-Hu Yan
- Department of Ultrasound, Shandong Public Health Clinical Center, Shandong University, Jinan 250013, Shandong Province, China
| | - Jing-Yu Chi
- Department of Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan 250013, Shandong Province, China
| | - Lei Zhang
- Department of Acupuncture and Massage, Shandong Provincial Third Hospital, Jinan 250000, Shandong Province, China
| | - Feng Xue
- Department of Radiology, Qilu Hospital, Shandong University, Jinan 250000, Shandong Province, China
| | - Jia Cui
- Department of Ultrasound, Shandong Public Health Clinical Center, Shandong University, Jinan 250013, Shandong Province, China
| | - Hai-Li Kong
- Department of Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan 250013, Shandong Province, China
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Ghanta PR, Phatak SV, Parihar PS, Dhande RP, Reddy NG. Radiological Evaluation of a Rare Case of Rib Caries and Cold Abscess in a Young Male Patient With Miliary Tuberculosis: A Case Report With Review of Literature. Cureus 2023; 15:e35075. [PMID: 36942180 PMCID: PMC10024632 DOI: 10.7759/cureus.35075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Rib caries with a cold abscess is a rare presentation of tuberculosis (TB) and is tricky to diagnose. It is rarer in young patients, especially in conjunction with active miliary TB. We present one such case of a 23-year-old male patient who presented with swelling over the left lower chest. Rib caries and cold abscess were initially detected by ultrasonography and elastography. The rib involvement and the extent of the cold abscess were further evaluated on a computed tomography scan, which also showed active pulmonary miliary TB. The patient was treated by aspiration of the cold abscess and anti-tuberculosis therapy. The fact that the patient had no history of diabetes, alcoholism, human immunodeficiency virus infection, or immunodeficiency disorder increases the rarity of this case. This case highlights the role of imaging in diagnosing rib caries, cold abscess, and miliary TB.
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Affiliation(s)
- Prasanthi R Ghanta
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suresh V Phatak
- Department of Radiodiagnosis, Narendra Kumar Prasadrao Salve Institute of Medical Sciences and Research Centre, Nagpur, IND
| | - Pratap S Parihar
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajasbala P Dhande
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nidhi G Reddy
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Li W, Sha W. Diagnosis of Chest Wall Tuberculosis Using Fine Needle Aspiration: A Single-Center Experience. Infect Drug Resist 2023; 16:2281-2290. [PMID: 37095781 PMCID: PMC10122463 DOI: 10.2147/idr.s404804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/29/2023] [Indexed: 04/26/2023] Open
Abstract
Introduction Minimally invasive diagnosis of chest wall tuberculosis remains a challenge. Fine needle aspiration (FNA) is a simple and safe method of sampling. However, previous studies have shown that conventional tuberculosis tests had poor diagnostic performance in the needle aspirates. With the popularization of molecular detection application, the value of FNA in the diagnosis of chest wall tuberculosis needs to be reevaluated. Methods We retrospectively studied patients with suspected chest wall tuberculosis at admission who underwent FNA for diagnosis and reported the diagnostic efficacy of acid-fast bacilli smear, mycobacterial culture, cytology and Xpert MTB/RIF (GeneXpert) when testing FNA specimens. A composite reference standard (CRS) was used as the diagnostic gold standard for this study. Results Among 89 included FNA specimens, acid-fast bacilli smear, mycobacterial culture, and GeneXpert were positive in 15 (16.85%), 23 (25.8%), and 61 (68.5%), respectively. Thirty-nine (43.8%) had cytologic features suggestive of tuberculosis. According to CRS, 75 (84.3%) cases were categorized as chest wall tuberculosis, 14 (15.7%) were not diagnosed with tuberculosis. Using CRS as the gold standard, acid-fast bacilli smear, mycobacterial culture, cytology and GeneXpert exhibited sensitivity of 20%, 30.7%, 52% and 81.3%, respectively. Specificity in these four tests was found to be 100%. Sensitivity of GeneXpert was significantly higher than that of smear, culture and cytology, X 2=66.3, p<0.001. Conclusion GeneXpert achieved higher sensitivity as compared to cytology and conventional TB tests in the chest wall FNA specimens. The implementation of GeneXpert may increase the diagnostic efficacy of FNA in the diagnosis of chest wall TB.
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Affiliation(s)
- Wenting Li
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People’s Republic of China
| | - Wei Sha
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People’s Republic of China
- Correspondence: Wei Sha, Shanghai Pulmonary Hospital, Tongji University, Number 507 Zhengmin Road, Shanghai, 200433, People’s Republic of China, Tel +86 21 6511 5006 (ext 2013), Fax +86 2155662767, Email
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Tumor and tumorlike conditions of the pleura and juxtapleural region: review of imaging findings. Insights Imaging 2021; 12:97. [PMID: 34236561 PMCID: PMC8266978 DOI: 10.1186/s13244-021-01038-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/11/2021] [Indexed: 01/09/2023] Open
Abstract
Pleural lesions form a diagnostic challenge for the radiologist. Whereas lesions can be initially detected on chest radiographs, CT and MRI imaging are the imaging modalities of choice for further characterization. In a number of cases, imaging findings can be relatively specific. In general unfortunately, imaging findings are rather aspecific. Evolution and extrathoracic imaging findings are important clues toward the diagnosis.
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Goravey W, Ali GA, Petkar M, Ammar A, Eldean MS, Al Maslamani MA, Abdel Hadi H. Ancient foe spectra: Case series of Mycobacterium tuberculosis presentations. Clin Case Rep 2021; 9:714-717. [PMID: 33598231 PMCID: PMC7869353 DOI: 10.1002/ccr3.3616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/29/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022] Open
Abstract
Extrapulmonary tuberculosis frequently eludes assessment through atypical presentations and constitute diagnostic challenges. High degree of suspicion with aids of GeneXpert MTB/RIF can clinch the diagnosis and avoid unnecessary consequences.
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Affiliation(s)
- Wael Goravey
- Department of Infectious DiseasesCommunicable Diseases CentreDohaQatar
| | - Gawahir A. Ali
- Department of Infectious DiseasesCommunicable Diseases CentreDohaQatar
| | - Mahir Petkar
- Department of Laboratory Medicine and PathologyHamad Medical CorporationDohaQatar
| | - Adham Ammar
- Department of Laboratory Medicine and PathologyHamad Medical CorporationDohaQatar
| | | | | | - Hamad Abdel Hadi
- Department of Infectious DiseasesCommunicable Diseases CentreDohaQatar
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Kabiri EH, Alassane EA, Kamdem MK, Bhairis M, Amraoui M, El Oueriachi F, El Hammoumi M. Tuberculous cold abscess of the chest wall: A clinical and surgical experience. Report of 16 cases(Case series). Ann Med Surg (Lond) 2020; 51:54-58. [PMID: 32099646 PMCID: PMC7029049 DOI: 10.1016/j.amsu.2020.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/22/2020] [Accepted: 02/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis is a public health problem in developing countries. Tuberculosis of the chest wall is rare and often presents as cold abscess (to differentiate from pyogenic abscess) or pseudotumoral mass whose diagnosis is difficult and often requires a surgical biopsy. Patients and methods The medical series of 16 patients with cold chest wall abscess treated with surgery in association to anti-tubercular therapy were analysed retrospectively for the period of 7 years between January 2011 to December 2017 at Mohamed V Military Teaching Hospital – Rabat - Morocco. Results The clinical examination provided a correct preoperative diagnosis of the abscess in all cases. Five patients had a past history of pulmonary tuberculosis and three patients had concomitant active infection. There were 6 cases on the left side, 9 cases on the right side and one case on the anterior chest wall. All patients underwent surgical drainage and debridement with specimens for bacteriology and histology. It was not necessary to resect ribs or sternum in all cases (sample costal or sternal curettage in one case each). Anti-tubercular treatment was routinely administered (6–9 months) with drug combinations of Isoniaside, Rifampicin, Pyrazinamide and Ethambutol. The evolution was favorable in all cases without complications or recurrences. Conclusion Drainage of chest wall abscess and complete debridement provide adequate treatment. Post-operative anti-bacillary therapy should be combined with surgical procedures to minimize local complications and recurrence of infection. Tuberculous abscesses of the chest wall well be associated pulmonary disease or primary location. Chest CT scan is the best exam to diagnosis and the procedure to do. Debridement must be large and in association with antituberculosis chemotherapy.
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Affiliation(s)
- El Hassane Kabiri
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco.,Faculty of medicine -Mohamed V University, Rabat, Morocco
| | | | | | - Mohamed Bhairis
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco
| | - Mouad Amraoui
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco
| | - Faycal El Oueriachi
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco
| | - Massine El Hammoumi
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco.,Faculty of medicine -Mohamed V University, Rabat, Morocco
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Abstract
Cross-sectional imaging modalities like MRI and CT provide images of the chest which are easily understood by clinicians. However, these modalities may not always be available and are expensive. Lung ultrasonography (US) has therefore become an important tool in the hands of clinicians as an extension of the clinical exam, which has been underutilized by the radiologists. Reinforcement of the ALARA principle along with the dictum of "Image gently" have resulted in increased use of modalities which do not require radiation. Hence, ultrasound, which was earlier being used mainly to confirm the presence of pleural effusion as well as evaluate it and differentiate solid from cystic masses, is now being used to evaluate the lung as well. This review highlights the utility of ultrasound of the paediatric chest. It also describes the normal and abnormal appearances of the paediatric lung on ultrasound as well as the advantages and limitations of this modality.
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Affiliation(s)
- Priscilla Joshi
- 1 Department of Radio-diagnosis and Imaging, Bharati Hospital and Research Center, Dhankawadi, Pune-Satara Road, Pune, Maharashtra, India
| | - Aishvarya Vasishta
- 1 Department of Radio-diagnosis and Imaging, Bharati Hospital and Research Center, Dhankawadi, Pune-Satara Road, Pune, Maharashtra, India
| | - Mayank Gupta
- 1 Department of Radio-diagnosis and Imaging, Bharati Hospital and Research Center, Dhankawadi, Pune-Satara Road, Pune, Maharashtra, India
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