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Cold abscess of the chest wall: a surgical entity?
E Faure1, R Souilamas, M Riquet
1Service de Chirurgie Thoracique, Hôpital Laennec, Paris, France.
The Annals of Thoracic Surgery
|November 4, 1998
Summary
Chest wall cold abscesses, a rare form of tuberculosis, often require surgery due to diagnostic challenges and variable treatment responses. Surgical intervention with antituberculous therapy is key for managing these rare tuberculous lesions.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Public Health
Background:
- Cold abscesses of the chest wall are rare manifestations of tuberculosis (TB).
- The resurgence of TB necessitates increased consideration of this diagnosis.
- Chest wall TB requires careful diagnostic and management strategies.
Purpose of the Study:
- To review the clinical characteristics, management, and outcomes of chest wall cold abscesses.
- To evaluate the role of surgery and medical treatment in managing these rare tuberculous lesions.
- To investigate the pathogenesis of chest wall tuberculous cold abscesses.
Main Methods:
- Retrospective study of 18 patients managed over a 15-year period (1980-1995).
- Analysis of epidemiologic data, surgical indications, operative methods, and outcomes.
- Review of diagnostic methods, including needle aspiration and computed tomography (CT).
Main Results:
- Most patients were immigrant men, with a high prevalence of prior TB (83%).
- Solitary lesions were common, frequently located on the rib shaft (60%).
- Diagnosis was often delayed; surgery was indicated for lack of response or diagnostic uncertainty, with lymph-borne dissemination suggested as the pathogenesis.
Conclusions:
- Fine-needle aspiration is an unreliable diagnostic tool for chest wall tuberculous cold abscesses.
- Antituberculous medical treatment alone is not consistently effective.
- Surgical management, combined with antituberculous therapy, remains the primary approach for most chest wall tuberculous cold abscesses.