Chang J H, Kim S K, Lee W Y
Department of Internal Medicine, College of Medicine, Seoul, Korea.
Respirology. 1999 Sep;4(3):249-53. doi: 10.1046/j.1440-1843.1999.00183.x.
The ribs and surrounding chest wall are uncommon sites of tuberculosis (TB). Tuberculosis of the rib bone is often delayed in diagnosis or is recurrent with medical treatment. Rib TB is often negative or shows nodular shadows which is mimicking a metastatic tumour. We reviewed 12 cases of rib TB, which were confirmed by surgical rib resection. The most common reason given for attending the hospital was palpation of the chest wall mass, the onset of chest pain or draining sinus on the chest wall. The correct diagnosis was often delayed due to misdiagnosis of the other conditions. The misdiagnosis was produced from vague symptoms and various radiological features of rib TB. Occasionally, previous TB history could provide an indication of rib TB. Occasionally, their pre-operative diagnostic processes were inadequate and were not consistent depending on the physician. From these reviews, we attempted to reconstruct the best diagnostic and therapeutic modalities. Our recommendation for detecting rib TB is an accurate medical history and physical examination, and early differential diagnosis with bone scintigram, computed tomogram, and percutaneous needle biopsy. Surgery can be a final diagnostic option for differential diagnosis or in a therapeutic role for recalcitrant or complicated cases.
肋骨及周围胸壁是肺结核（TB）的少见发病部位。肋骨结核的诊断常常延迟，或经药物治疗后复发。肋骨结核通常呈阴性或表现为结节状阴影，易被误诊为转移性肿瘤。我们回顾了12例经肋骨手术切除确诊的肋骨结核病例。就医的最常见原因是胸壁肿物触诊、胸痛发作或胸壁出现引流窦道。由于误诊为其他疾病，正确诊断常常延迟。肋骨结核症状模糊且有多种影像学特征，从而导致误诊。偶尔，既往结核病史可提示肋骨结核。有时，其术前诊断过程不充分，且因医生不同而不一致。通过这些回顾，我们试图重建最佳的诊断和治疗模式。我们建议，检测肋骨结核需详细准确的病史和体格检查，并通过骨闪烁扫描、计算机断层扫描和经皮穿刺活检进行早期鉴别诊断。手术可作为鉴别诊断的最终诊断选择，或用于治疗顽固或复杂病例。
