Sonographic Features of a Tuberculous Cold Abscess: A Case Report and Literature Review

Abstract

The use of point of care ultrasound (POCUS) to aid diagnosis of tuberculosis has been investigated in countries where concomitant endemic prevalence of HIV increases the incidence of extrapulmonary tuberculosis (EPTB). In such cases, using a focused assessment with sonography for HIV-associated tuberculosis (FASH) scan has found to be immensely advantageous as a rapid diagnostic tool in low resource settings where other imaging modalities are scarce. The prevalence of EPTB in immunocompetent patients in industrialised countries is growing. Since EPTB can manifest itself in almost any part of the human body, symptomatic patients present with constitutional and non-specific symptoms. In our case, a 44-year-old male presented to the emergency department (ED) with a 3-month history of left-sided chest pain and swelling of the chest wall. Clinical examination revealed a swollen and tender lump above the left first rib. Palpation of the thoracic (T7) vertebral body demonstrated localised pain. POCUS showed a collection of heterogenous material with fluid content and specks of hyperechoic ‘ring-like’ structures. Further investigations led to the diagnosis of EPTB. The patient was admitted and treated for EPTB where he went on to make a full recovery. This case report highlights the role of integrating POCUS in clinical examination of patients with suspected EPTB, which can expedite its diagnosis and management.

Chest wall tumor following intravesical BCG instillation for non-muscle invasive bladder cancer

“…Primary chest wall sarcomas (typically chondrosarcomas and fibrosarcomas in approximately up to 80 % of cases) and recurrent breast cancers account for the most common malignancies [28] . The leading infectious causes for chest wall tumors comprise extrapulmonary tuberculosis and actinomyces (<5% of cases) [29] , [30] . In either case, a pre-therapeutic biopsy is mandatory.…”

Musculoskeletal Tuberculosis of the Pectoralis With Bilateral Pleural Base Nodular Lesions: A Rare Report of Its Type in an Immunocompetent Female

“…Mycobacterium tuberculosis can invade practically any area of the body, resulting in disease. Twenty to thirty percent of cases of extrapulmonary tuberculosis involve the musculoskeletal system, and the spinal bones continue to be the most common site of infection [ 9 ]. Further, musculoskeletal tuberculosis is commonly seen in immunocompromised patients and is infrequent in immunocompetent individuals like the present case.…”

“…Based only on the history and physical examination, the diagnosis of tuberculosis of the pectoralis muscles might be challenging because of the multitude of vague signs and symptoms. As a result, it calls for specialized investigations and a high degree of suspicion in the patients who report chest wall swellings, especially in the absence of constitutional signs and symptoms of tuberculosis [ 9 ]. However, this could cause a delay in the diagnosis and treatment.…”

“…Ultrasound-guided needle aspiration followed by smears or culture, as done in this case, is indicated to determine the underlying cause [ 9 , 10 ]. However, this procedure has its limitations, giving ambiguous results and having a 36.3% success rate for a definite diagnosis.…”