CTICasesPulmonary Tuberculosis with Chest Wall Cold Abscess
Imaging findings
Chest radiograph demonstrates upper lung consolidation, cicatrization, and apical scarring. CT of the chest reveals advanced active pulmonary tuberculosis with tree-in-bud opacities and a large, fluid-attenuation soft-tissue collection representing a cold abscess that tracks directly through the chest wall and presents as an external soft-tissue bulge.
Key takeaways
Tuberculosis can spread beyond the lung parenchyma and pleural space to form a chest wall cold abscess, a process historically termed empyema necessitans or tuberculosis necessitates. Although classical definition required a draining cutaneous fistula, modern clinical usage includes any tuberculous chest wall collection with the propensity to rupture, typically arising from direct extension of pleural disease.
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