Tuberculosis of the ribs: CT appearance

Tuberculosis is the most common inflammatory lesion of the ribs, second only to metastatic neoplasm as a destructive cause of a rib lesion. We retrospectively analyzed CT findings of 13 lesions in eight patients with pathologically proven rib tuberculosis. The presenting symptoms were painful mass in five, chest pain in two, and nontender mass in one. Five patients had concomitant pulmonary tuberculosis. On CT, all showed a juxtacostal soft tissue mass with central low attenuation and peripheral rim enhancement (a so called "cold abscess"). Only 4 of 13 lesions demonstrated bone destruction: two were osteolytic expansile lesions with cortical disruption and two were mild cortical irregularities. Five lesions were located at the costochondral junction, five were in the rib shaft, two were in the sternochondral junction, and one was in the costovertebral joint. There was no evidence of direct extension into the lung parenchyma.