[Manifestation of lung tuberculosis as soft tissue tumor (gravitation abscess in mediastinal lymphadenitis) of the thoracic wall in a 32-year-old woman]

In a 32-year-old female appeared after a period of weeks with pain in the back and left flank a tumor (8 x 6 cm in size) in the anterior axillary line (9.-11. rib). The patient was afebril and in good condition. X-rays and Contrast-CT findings showed round shaped infiltrations in both upper lobes of the lung, widening of the mediastinum (right paratracheal) and left pleural effusion. The mediastinal mass showed "rim enhancement" and "central low density areas", which is typical for liquefaction of caseous material in tuberculous lymphadenitis and gravitation abscess. The tumor was resected incompletely, because there was connection to the 8. intercostal space. In the cross-section the tumor appeared grey-white, histologically there was caseous material surrounded by epitheloid cells and Langhans giant cells, as to see in tuberculous gravitation abscess. Ziehl-Neelsen-staining of resected material and bronchial secret was negative, but of both specimen Mycobacterium tuberculosis was cultured. The patient got a therapy with INH, Ethambutol, Pyrazinamid and Rifampicin. Regression of the parenchymal fokus and the mediastinal lymphadenitis was observed.