MANAGEMENT OF PRIMARY CHEST-WALL TUBERCULOSIS

Primary tuberculosis of the chest wall is rare and its clinical presen tation may resemble pyogenic abscess or tumour. The diagnosis is diffi cult, since smears or cultures of aspirate frequently fail to show tub ercle bacilli. Seven cases of primary chestwall tuberculosis treated b etween 1973 and 1992 are described. All presented with a progressively enlarging mass. The diagnosis was based on bacteriologic and histolog ic findings, but definitive diagnosis was obtained before treatment in only two cases. Satisfactory results were obtained with surgical debr idement and specific chemotherapy in six cases and with chemotherapy a lone in one case. From this limited experience, we suggest that primar y chestwall tuberculosis should initially be treated with a combinatio n regimen of antituberculous chemotherapy, which should take more than 9 months. If the lesion progressively enlarges or secondary infection occurs, however, adequate surgical debridement is also required.