Two Cases of Chest Wall Tuberculosis following Chest Drainage which was Treated Surgically

Abstract

We have experienced two cases of chest wall tuberculosis which developed after chest drainage for tuberculous pleurisy at the site where a chest tube was placed. These patients were treated by excision of a chest wall abscess and musculoplasty under general anesthesia, with a favorable postoperative course.

Case 1 involved an 83-year-old man who presented with dyspnea. He had right pleural effusion and multiple nodular shadows in the right upper lobe of the lung, and right chest drainage was performed. Since a sputum test resulted in TB-PCR positive, antituberculous medical treatment was started. Three months later, pus discharge began and persisted from a site where the chest tube was removed. We thus performed excision of the chest wall abscess and serratus anterior muscle flap plombage. Case 2 involved a 65-year-old man who presented with dyspnea. He had left pleural effusion, left chest wall abscess and a shadow in the right upper lobe of the lung. We performed left chest drainage and puncture of the left chest wall abscess, that revealed the content of chest wall abscess to be TB-PCR positive. Then antituberculous medical treatment was started. Two months later pus discharge began and persisted from a site where the thoracic tube was removed. We thus performed excision of the thoracic wall abscess and latissimus dorsi musculocutaneous flap plombage.

We consider that surgical treatment is an available option for chest wall tuberculosis with a cutaneous fistula developed during internal treatment.