
==== Front
Respirol Case Rep
Respirol Case Rep
10.1002/(ISSN)2051-3380
RCR2
Respirology Case Reports
2051-3380
John Wiley & Sons, Ltd Chichester, UK

10.1002/rcr2.70029
RCR270029
Clinical Image
Clinical Image
Chest wall subcutaneous mass leading to the diagnosis of pericostal tuberculosis
COLD ABSCESS IN PERICOSTAL TUBERCULOSIS
Kajie et al.
Kajie Shimpei https://orcid.org/0009-0008-2621-7386
1 skajie0325@gmail.com

Nakamura Kentaro 1
Moriya Tomohiro https://orcid.org/0000-0003-1026-2357
1
Ogata Tomoyuki 1
Yamashita Takaaki 1
1 Department of Respiratory Medicine JA Toride Sogo Iryo Center Toride Japan
* Correspondence
Shimpei Kajie, Department of Respiratory Medicine, JA Toride Sogo Iryo Center, Toride, Ibaraki, Japan.
Email: skajie0325@gmail.com

18 9 2024
9 2024
12 9 10.1002/rcr2.v12.9 e7002902 9 2024
13 9 2024
© 2024 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Abstract

When diagnosing a chest wall mass, even in the absence of pulmonary lesions, it is crucial to consider pericostal tuberculosis as a differential diagnosis. Attention must be paid to the characteristic findings on contrast‐enhanced computed tomography, such as central low attenuation, peripheral rim enhancement of soft tissue, and pleural involvement.

Pericostal tuberculosis is characterized by central low attenuation and peripheral rim enhancement of soft tissue on contrast‐enhanced computed tomography. When diagnosing a chest wall mass, even in the absence of pulmonary lesions, it is crucial to consider pericostal tuberculosis as a differential diagnosis.

chest wall tuberculosis
cold abscess
contrast‐enhanced CT
pericostal tuberculosis
source-schema-version-number2.0
cover-dateSeptember 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:19.09.2024
Kajie S , Nakamura K , Moriya T , Ogata T , Yamashita T . Chest wall subcutaneous mass leading to the diagnosis of pericostal tuberculosis. Respirology Case Reports. 2024;12 (9 ):e70029. 10.1002/rcr2.70029

Associate Editor: Jennifer Ann Wi
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pmcAn 86‐year‐old man presented with a left anterior chest wall mass that had been present for 2 months. He had undergone low anterior resection for colorectal cancer 6 years earlier. He was afebrile with normal vital signs. On physical examination, a 6‐cm mass without redness or tenderness was palpated in the left anterior chest. Contrast‐enhanced computed tomography (CT) showed a 51‐mm subcutaneous mass in the left anterior chest wall that communicated with the pleural cavity (Figure 1). Contrast‐enhanced CT performed 1 year earlier showed a calcified mass in the left parietal pleura (Figure 2). An ultrasound‐guided biopsy of the subcutaneous mass was performed. A Mycobacterium tuberculosis PCR test of the specimen was positive. Culture of the biopsy specimen confirmed the presence of M. tuberculosis, leading to a diagnosis of pericostal tuberculosis. Treatment with anti‐tuberculosis medication was initiated, resulting in a reduction in the lesion size. Pericostal tuberculosis is characterized by central low attenuation and peripheral rim enhancement of soft tissue on contrast‐enhanced CT. 1 Diagnosis is achieved in one‐third of cases through an acid‐fast bacilli smear and culture of the biopsy specimen, and surgical intervention is effective. 2 When evaluating chest wall masses, it is crucial to focus on the characteristic findings on contrast‐enhanced CT and pleural involvement.

FIGURE 1 (A) Contrast‐enhanced computed tomography reveals a 51‐mm subcutaneous mass in the left anterior chest wall, with continuity to an intrathoracic mass and evidence of lytic changes in the rib. (B) The subcutaneous mass in the left anterior chest wall exhibits central low attenuation and peripheral rim enhancement.

FIGURE 2 (A, B) Contrast‐enhanced computed tomography performed 1 year earlier reveals a mass with calcification in the left parietal pleura.

AUTHOR CONTRIBUTIONS

Shimpei Kajie managed the patient and wrote the original manuscript. Tomohiro Moriya critically revised the report. All authors reviewed and approved the final version of the manuscript.

CONFLICT OF INTEREST STATEMENT

None declared.

ETHICS STATEMENT

The authors declare that appropriate written informed consent was obtained for the publication of this manuscript and accompanying images.

ACKNOWLEDGMENTS

We thank Dr. Kelly Zammit, BSc, BVSc, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript. This case was presented at the 258th Kanto Regional Meeting of the Japanese Respiratory Society, Tokyo, 2024.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.
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