Chest Wall Tuberculosis

Chest wall TB is secondary TB of the ribs, sternum, or soft tissues from pulmonary/pleural infection, a common chest wall disorder. It affects young/middle-aged adults (20-40), more males, preferring the 3rd-7th ribs between the breast and posterior axillary line. It presents as cold abscess or chronic sinus, usually a local manifestation of pulmonary, pleural, or mediastinal TB. Most patients have no obvious symptoms or only mild reactions like low fever, night sweats, weakness, and local pain.

Common Symptoms

Tuberculous toxicity; bony destruction; secondary infection; blood-streaked sputum; night sweats; fatigue; low fever; weight loss; abscess

Causes and Pathogenesis

Chest wall TB is mostly secondary; the most common primary lesions are pulmonary TB, pleural TB, or mediastinal lymph node TB. The degree of chest wall involvement does not parallel pulmonary/pleural severity; by the time a chest wall abscess appears, the primary focus may be static or healed. Primary tuberculous osteomyelitis of rib/sternum is rare. Pathogenesis: From pulmonary/pleural TB: 1. Lymphatic route (most common): bacilli spread from primary foci via adhesions to parasternal, paraspinal, or intercostal nodes, then penetrate into soft tissues forming abscesses. 2. Direct spread: superficial pulmonary/pleural foci destroy the parietal pleura and penetrate intercostal muscles, often forming hourglass-shaped cavities above and below the muscle; gravity makes abscesses track down to the lateral chest or upper abdomen; secondary infection causes spontaneous rupture or chronic sinuses. 3. Hematogenous spread (rare, in very low immunity): bacilli seed ribs/sternum causing tuberculous osteomyelitis; cortical destruction then invades soft tissues. Regardless of route, late disease destroys chest wall tissues.

Treatment

Rehabilitation, surgical treatment, supportive therapy

Preventive Measures

1. Health education on TB hazards and transmission; do not spit; burn or chemically disinfect patient sputum. 2. Periodic physical exams for early detection/isolation/treatment; vaccinate infants with BCG. 3. Seek prompt care for low fever, night sweats, dry cough, or blood-streaked sputum; treat immediately with streptomycin, isoniazid, ethambutol, and increase nutrition. With early detection and thorough treatment, TB is fully curable.

Department to Visit

It is recommended to visit the Infectious Diseases department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.