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Chen L, Zhou W, Hu P, Zhou Z. A series of tuberculous cold abscesses at uncommon anatomic sites. Quant Imaging Med Surg 2023; 13:5393-5397. [PMID: 37581047 PMCID: PMC10423395 DOI: 10.21037/qims-22-743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 05/15/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Lei Chen
- Department of Radiology, Minhang Branch, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wenshen Zhou
- Department of Radiology, Luchun County People’s Hospital of Yunnan Province, Honghe, China
| | - Peian Hu
- Department of Radiology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Zhengrong Zhou
- Department of Radiology, Minhang Branch, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Rea G, Sperandeo M, Lieto R, Bocchino M, Quarato CMI, Feragalli B, Valente T, Scioscia G, Giuffreda E, Foschino Barbaro MP, Lacedonia D. Chest Imaging in the Diagnosis and Management of Pulmonary Tuberculosis: The Complementary Role of Thoraci Ultrasound. Front Med (Lausanne) 2021; 8:753821. [PMID: 34957142 PMCID: PMC8703038 DOI: 10.3389/fmed.2021.753821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/11/2021] [Indexed: 01/11/2023] Open
Abstract
Tuberculosis (TB) is a severe infectious disease that still represents a major cause of mortality and morbidity worldwide. For these reasons, clinicians and radiologists should use all the available diagnostic tools in the assessment of the disease in order to provide precise indications about starting an anti-tubercular treatment and reduce risk of TB transmission and complications especially in developing countries where the disease is still endemic. As TB mycobacteria are mainly transmitted through respiratory droplets, the pulmonary parenchyma is usually the first site of infection. As a result, chest imaging plays a central role in the diagnostic process. Thoracic ultrasound (TUS) is a portable, non-invasive, radiation-free, and cost-contained technology which could be easily available in resource-limited settings. This perspective article focuses on the potential role of TUS in the diagnosis and management of patients with pulmonary TB. Unfortunately, there are still insufficient evidence and too contrasting data to judge TUS as an appropriate diagnostic method for the screening of the disease. Despite this, TUS may have a useful role in identifying pleural and anterior pericardial effusions or in the identification of abscesses of the anterior chest wall and paraspinal collections in low- and middle-income settings. In addition, TUS seems to have a milestone role in guiding minimally invasive interventional procedures, such as placement of chest tubes, drainage of loculated collections, thoracentesis and pericardiocentesis, and percutaneous biopsy of subpleural pulmonary consolidations or pleural plaques.
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Affiliation(s)
- Gaetano Rea
- Department of Radiology, Azienda Ospedaliera dei Colli-Cotugno and Monaldi Hospital, Naples, Italy
| | - Marco Sperandeo
- Department of Medical Sciences, Unit of Interventional and Diagnostic Ultrasound of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Roberta Lieto
- Department of Radiology, Azienda Ospedaliera dei Colli-Cotugno and Monaldi Hospital, Naples, Italy
| | - Marialuisa Bocchino
- Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario "Riuniti" di Foggia, University of Foggia, Foggia, Italy
| | - Beatrice Feragalli
- Department of Medical, Oral and Biotechnological Sciences - Radiology Unit "G. D'Annunzio", University of Chieti-Pescara, Chieti, Italy
| | - Tullio Valente
- Department of Radiology, Azienda Ospedaliera dei Colli-Cotugno and Monaldi Hospital, Naples, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario "Riuniti" di Foggia, University of Foggia, Foggia, Italy
| | - Ernesto Giuffreda
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario "Riuniti" di Foggia, University of Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario "Riuniti" di Foggia, University of Foggia, Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario "Riuniti" di Foggia, University of Foggia, Foggia, Italy
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Kakamad FH, Hassan MN, Salih AM, Ahmed GS, Abdullah BA, Mohammed SH. Primary chest wall tuberculosis mimicking gynecomastia: A case report. Int J Surg Case Rep 2020; 75:473-475. [PMID: 33076198 PMCID: PMC7527615 DOI: 10.1016/j.ijscr.2020.09.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/15/2023] Open
Abstract
Tuberculosis is an airborne infectious disease. Musculoskeletal TB is a rare variant of the condition. Involvement of the chest wall is even rarer. In this report, a case of chest wall tuberculosis has been presented.
Introduction Musculoskeletal tuberculosis (TB) is a rare variant of the disease. Involvement of the chest wall is even rarer. This paper aims to report a case of primary chest wall TB mimicking gynecomastia. Case report An 11-year-old male presented with gradual left breast enlargement for one year duration, clinically diagnosed as a case of gynecomastia. On examination; there was a firm swelling involving left anterior chest wall elevating the nipple and areolar region. Ultrasound showed thick wall cystic lesion with internal debris and bone erosion. Computed tomography scan (CT scan) of the chest revealed a cystic lesion containing fluid with a similar cystic lesion in the substernal area. Under general anesthesia, through an anterolateral incision, a thick wall cystic lesion with a very thick pus content was found connecting to another similar lesion in the anterior mediastinum with a localized thickening of the pleura. Both of the lesions, and the fifth rib with a part of the fourth rib were resected and sent for histopathological examination which revealed multiple granulomas with caseating material, typical for tuberculosis. Discussion Pathogenesis of chest wall TB has been explained by one or more of the three mechanisms: due to direct extension from an underlying disease; hematogenous dissemination, and direct extension from neighboring affected lymph node groups in the chest wall. Conclusion Chest wall TB is a rare condition. It can mimic other pathologies due to nonspecific signs and symptoms. Surgical debridement with postoperative chemotherapy is the most effective strategy of management.
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Affiliation(s)
- Fahmi H Kakamad
- College of Medicine, Department Cardiothoracic and Vascular Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq.
| | - Marwan N Hassan
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq; College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Abdulwahid M Salih
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Medicine, Department of General Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Gasha S Ahmed
- College of Health Sciences, Medical Laboratory Science Department, University of Human Development, Sulaimani, Kurdistan, Iraq
| | - Berwn A Abdullah
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Shvan H Mohammed
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
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Boruah DK, Sanyal S, Sharma BK, Prakash A, Dhingani DD, Bora K. Role of Cross Sectional Imaging in Isolated Chest Wall Tuberculosis. J Clin Diagn Res 2017; 11:TC01-TC06. [PMID: 28274020 DOI: 10.7860/jcdr/2017/23522.9185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/08/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Isolated chest wall tuberculosis though a rare entity, the incidence of it has been on rise among immunocompromised population making it an important challenging diagnosis for the physicians. Its clinical presentation may resemble pyogenic chest wall abscess or chest wall soft tissue tumour. Sometimes it is difficult to detect clinically or on plain radiograph. AIM The present study was conducted with an aim to evaluate the common sites and varying appearances of isolated chest wall tuberculosis. MATERIALS AND METHODS A hospital based cross-sectional retrospective study was conducted in Assam Medical College and Hospital, a tertiary care centre in North East India. The study group comprise of 21 patients (n=15 male and n=6 females) with isolated chest wall tuberculosis without associated pulmonary or spinal involvement who were subjected to Computed Tomography/Magnetic Resonance Imaging (CT/MRI) of the thorax following initial Ultrasonogram (USG) evaluation of the local site. Pathological correlation was done from imaging guided sampling of the aspirate or surgery. RESULTS Variable sites of involvement were seen in the chest wall in our patients (n=21), with chest wall abscess formation being the most common presentation and rib being the most common bony site affected in the thoracic cage. Bony sclerosis was noted in 11 patients (52.4%), periosteal reaction in 10 patients (47.6%) and sequestration in five patients (23.8%). CT/MRI not only localized the exact site and extent of the abscesses which facilitated guided aspirations, but also helped in detecting typical bony lesions thereby, differentiating from pyogenic osteomyelitis besides ruling out associated pulmonary or pleural involvement in such patients. CONCLUSION Cross-sectional imaging plays an important role by giving a wholesome picture of both soft tissue and bony pathology. It is important to have adequate understanding of the radiologic manifestations of the chest wall involvement and complications of tuberculosis to facilitate diagnosis and in assessing response to treatment on follow up in patients.
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Affiliation(s)
- Deb Kumar Boruah
- Assistant Professor, Department of Radiodiagnosis, Assam Medical College , Dibrugarh, Assam, India
| | - Shantiranjan Sanyal
- Consultant Radiologist, Department of Radiology, Airedale General Hospital , Keighley, West Yorkshire, United Kingdom
| | - Barun K Sharma
- Associate Professor, Department of Radiology, Sikkim Manipal Institute of Medical Sciences , Gangtok, Sikkim, India
| | - Arjun Prakash
- Postgraduate Student, Department of Radiodiagnosis, Assam Medical College , Dibrugarh, Assam, India
| | - Dhabal D Dhingani
- Postgraduate Student, Department of Radiodiagnosis, Assam Medical College , Dibrugarh, Assam, India
| | - Karobi Bora
- Postgraduate Student, Department of Radiodiagnosis, Assam Medical College , Dibrugarh, Assam, India
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