Tuberculous chest wall abscess are uncommon, however, during last 3 years we have seen a sudden surge in the cases. This prospective study was conducted to find out the pattern of chest wall abscess, the relation with tuberculosis of adjacent organs and its association with HIV infection.METHOD: All patients with complaints of chest wall and lower neck swelling were included in the study. Diagnosis of tuberculous cold abscess was made by clinicoradiological assessment, AFB smear/culture, MT with 10 TU and histopathologicalexamination of the aspirated material currettaged tissue.
Out of 40 pts. studied, the male to female ratio was 1:4. 38 patients (95%) were in age group 15-25 years. 65% had solitary abscess & 35% had multiple abscesses. Majority of abscess were in supraclavicular (38%), infraclavicular (26%) and suprasternal notch (17%) 9% multiple abscess had interconnection sonographically. Average size of abscess was 4x5cm. Only one patient was HIV seropositive. Surgical intervention was required in almost all pts. Relapse was noticed in 7.8% Post operatively all patients were given ATT for 6-9 months. No pt. showed MDR strain
This study has broken the myth that chest wall abscesses are more common in HIV seropositives. Repeated antigravity draniage and currettage required in 92% In 36% patients we had to add prednisolone 1 mg / kg. for variable periodCLINICAL IMPLICATION: Tuberculous cold abscess of chest wall and lower neck is increasing in day to day practice, probably due to hightened hypersensitivity reaction to tubercular protein or as a paradoxical reaction Cases should be screened properly & combined surgical and medical intervention required.
R.C. Gupta, None.