Chest Wall Tuberculosis: Clinical Features and Treatment Outcomes

Empyema necessitans (EN) as a rare complication of tuberculosis - A case report

INTRODUCTION

Empyema necessitans (EN) is an uncommon condition where an intrathoracic empyema extends into surrounding extra-thoracic tissues. This case report presents a rare instance of tuberculous EN in an immunocompetent individual.

PRESENTATION OF CASE

We present a case of a healthy young male with complaints of weight loss and a chest wall swelling, initially treated as a subcutaneous abscess. He had a history of TB contact and initial laboratory tests showed elevated CRP and ESR, with no bacterial growth on initial culture from FNAC sample. Subsequent imaging revealed the presence of pleural empyema. Following surgical intervention, a connection between fluid collection outside the thoracic wall and the pleural cavity was identified. Diagnosis of tuberculous EN was made on results of second culture of the fluid collection. The patient was further treated with anti-tuberculous treatment.

DISCUSSION

EN, rare extrapulmonary complication of tuberculosis, is challenging to diagnose due to nonspecific symptoms and paucibacillary nature of extrapulmonary TB. Imaging plays a crucial role in diagnosis. A multidisciplinary approach involving surgery and anti-tuberculous treatment is effective in managing EN.

CONCLUSION

This case underscores the scarcity of EN occurrences and emphasizes the potential for latent TB to surface as atypical complications. Accurate diagnosis requires a combination of clinical insight, imaging, and laboratory tests. EN should be considered in individuals with chest wall masses, particularly in TB endemic areas, and those with a history of TB contact. Treatment involves surgical intervention and anti-tuberculous therapy.

Use of ballasted flocculation (BF) sludge for the manufacturing of lightweight aggregates

Ballasted flocculation (BF) is an efficient way to remove the turbidity from surface water. The objective of the present study is to optimize the ballast (magnetite), coagulant (poly aluminum chloride) concentration and pH for efficient turbidity removal from surface water. To do this, the sludge produced from an optimized dose of a BF treatment was utilized for the production of lightweight (LW) aggregates by combining it with hard clay and sewage sludge. The LW aggregates were formed by means of rapid sintering in the temperature range of 1000-1200 °C with an exposure time of 10 min. The physical properties of the LW aggregates, in this case the leaching of heavy metals, the bulk density and the microstructure, were investigated. The results indicated that corresponding ballast and coagulant concentrations of 0.75 g/L and 30 mg/L (poly aluminum chloride (PAC)) resulted in the maximum removal efficiency of ≈95%. Using a mixture of BF sludge (30 wt%), dry sewage sludge (20 wt%), and hard clay (50 wt%), aggregates with a density of around 1.0 g/cm³ could be produced. In addition, it was confirmed that the manufactured aggregate was environmentally stable as the elution of heavy metals was suppressed.

Primary chest wall tuberculosis mimicking gynecomastia: A case report

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Tuberculosis is an airborne infectious disease.

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Musculoskeletal TB is a rare variant of the condition.

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Involvement of the chest wall is even rarer.

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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.

Tuberculous retropharyngeal abscess with Pott disease and tuberculous abscess of the chest wall: A case report

RATIONALE

Tuberculous retropharyngeal abscess is rare, but it can be fatal if not treated appropriately. It usually occurs secondary to tuberculosis of the cervical spine. Moreover, tuberculous abscess involving the chest wall is relatively rare in skeletal tuberculosis. Although the optimal treatment is controversial, most clinicians suggest a combination of sufficient antituberculous medication and complete resection to prevent recurrence and increase therapeutic efficacy. Herein, we present an unusual case of retropharyngeal abscess with cervical Pott disease and tuberculous abscess of the chest wall.

PATIENT CONCERNS

The patient was a 27-year-old Indonesian woman who had neck pain, dysphagia, and odynophagia, but no neurological deficit. Examination of the oral cavity showed anterior displacement of the posterior pharyngeal wall. The mass over the right anterior chest wall measured approximately 5 × 4 cm in size.

DIAGNOSES

Radiography and computed tomography findings were suggestive of retropharyngeal abscess extending to the cervical spine and chest wall abscess.

INTERVENTIONS

She was admitted to the hospital for treatment. Drainage of the retropharyngeal and chest wall abscesses with debridement of the chest wall was performed.

OUTCOMES

No complications occurred after early surgical treatment and administration of antituberculous medication. The patient recovered well and went back to her own country after discharge.

LESSONS

Tuberculous retropharyngeal abscess with Pott disease and tuberculous abscess of the chest wall are both complicated diagnoses that physicians have to consider in similar patient presentations.

Tuberculous Empyema Necessitatis in a 40-Year-Old Immunocompetent Male

Empyema necessitans (EN) is a kind of empyema that diffuses to extrapleural space and can involve chest pain. Tuberculosis (TB) is the most common cause of EN. This disease can be found in both immunocompromised and immunocompetent individuals but is usually seen in the immunocompromised individuals. Because of long duration and ambiguous symptoms of the disease, diagnosis can be hard. The disease can be treated both medically and surgically. Missing the disease can lead to undesirable effects on patient's condition and health care setting. This problem can be seen in endemic area in which controlling of TB is hard. Report of the disease in local health care center for desirable treatment and health maintenance is necessary. We explained a rare case of pulmonary TB in a patient that was healthy in other fields and just showed the minimum systemic symptoms. The patient came with a mass in lower part of back of chest cage, with a mild pain. The imaging survey showed EN. Smear and Ziehl-Neelsen stains from subcutaneous aspiration were positive for TB. This case showed importance of clinical view and awareness of this silent but serious disease in endemic area especially for TB.

Two Rare Cases Involving the Spread of Tuberculosis: A Tuberculous Abscess of the Chest Wall Invading the Liver by Way of the Diaphragm

We herein report two separate cases in which a tuberculous abscess of the chest wall invaded the liver by penetrating through the diaphragm. After confirming the presence of tuberculous lesions in the chest wall and liver, both patients received preoperative anti-tuberculosis (TB) medications for two weeks; after which, the lesions were surgically removed. Following surgery, both patients fully recovered and were asymptomatic, but continued to receive routine postoperative care involving anti-TB medications. Neither patient showed recurrence of TB during a 15-month follow-up period.

[Chest wall tuberculosis: report of 3 cases]

Despite the dramatic decline in the incidence of tuberculosis during the last decades, the disease remains a significant public health problem especially in developing countries. Chest wall tuberculosis is a very rare location. Clinically, it can present as a pyogenic abscess or soft tumor, making diagnosis difficult, particularly in the absence of warning signs. Optimal therapeutic management is controversial. Medical treatment alone in often insufficient and must be associated with a surgical excision or debridement.