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Introduction Chest wall masses are caused by various entities and have diverse aetiologies. A careful history and physical examination are crucial to establish the correct diagnosis. Case report A 77-year-old man presented with depressive mood, anorexia (weight loss of 20 kg) and a 1-month history of a non-painful breast lump with well-defined contours, which was about 6 cm in diameter. There was no history of trauma. Computed tomography of the thorax revealed a collection of liquid in the left anterior thoracic wall, associated with discontinuity of the 4th left costal cartilage, and upper left lobe cavitation, suggesting pulmonary tuberculosis. The patient was started on quadruple therapy with anti-tuberculosis drugs and discharged after a negative smear. Conclusion In this case, the indolent onset of unspecific symptoms made it difficult to reach a diagnosis of pulmonary tuberculosis, which was confirmed by positive culture and imaging. A breast lump in an elderly patient with unspecific clinical manifestations is an unusual presentation of pulmonary tuberculosis. It is important to be aware of rib invasion and exclude tuberculosis in a patient with a chest wall mass. As tuberculosis is treatable, early diagnosis is vital as diagnostic delay can lead to contagion. LEARNING POINTS Chest wall tuberculosis is a rare complication of pulmonary tuberculosis. As smears and acid-fast bacilli cultures are often negative, polymerase chain reaction and imaging should be performed. Tuberculosis should be treated with first-line drugs; the role of surgery is still controversial.

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