Many synonymous names i.e. rib caries, cold abscess of the chest wall, pericostal abscess, lymphadenitis tuberculosa of the chest wall, etc. were used, for the cold abscess occurring on the chest walls, however, judging from the mechanism of it´s pathogenesis it seems reasonable to call as tuberculous abscess on the chest wall.
Based on the observation of our 5 cases of tuberculous abscess on the chest wall, it´s mechanism of occurence, treatment and implications with so called "rib caries" will be considered.
Although it has been said that the tuberculous abscess on the chest wall developes as a secondary disease of so called "rib caries," our 5 cases; 3 of them with antibiotic treatment showed tuberculoma like lessons encapsulated by fibrotic layer situated on chest walls extra-pleurally simulating tumors occurred on the pleura itself on rentgenological findings while other 2 cases with no previous antibiotic treatment showed subcutaneous abscesses which apparently originated from the caseated and liquefied tuberculous lesions situated on the extra-pleural chest walls, revealed no pathologic findings on the ribs or sternum.
It is not known for sure whether our 5 cases had lesions on their parasternal lymphnodes but all of them had past histories of pleurisy and particulary in 3 cases who had thoracotomy to remove tuberculorna like lesion we found severe pleural adhesions for it is probable-,on these cases tuberculous bacilli induced cold abscesses on chest walls via the adherent pleura and this seems to coincide with recent medical literature´s. Since-we found no tuberculous lesions on ribs from our cases it can be said that cold abscesses were nott originated from ribs therefore we advocate that the words "rib caries" should. not be used unless there is a primary tuberculous lesion on the rib.
On x-ray examination, tuberculoma-like lesions located underneath the ribs are difficult to differentiate with´tuberculoma of the lung parenchyma and tumors originated primarily from the pleura.
With antibiotic administration, wide incision on the lesion, through curettage, proper draining of liquefied materials and rib resection, if needed, are helpful for the treatment of the subcutaneous cold abscess on the chest wall and encapsulated lesions can be removed by thoracotomy with appropriate rib resection.
|