Abid M, Ben Amar M, Abdenadher M, Kacem A Haj, Mzali R, Mohamed I Beyrouti
Service de chirurgie générale, EPS Habib Bourguiba, 3029 Sfax, Tunisie.
Rev Mal Respir. 2010;27(1):72-5. doi: 10.1016/j.rmr.2009.11.010. Epub 2009 Dec 31.
Isolated thoracic parietal involvement is a very rare form of tuberculosis and multifocal localization is exceptional. It often poses a diagnostic problem with parietal tumours requiring recourse to surgical biopsy. We report a case of tuberculous abscess localized to the anterior and superior part of the chest wall with a second abdominal localization but without any pulmonary involvement. The patient was a woman of 56 years presenting with a one-year history of a swelling to the right of the sternum accompanied after several months by a second swelling to the right side of the abdomen. The radiological and biological investigations revealed a parietal tumour in two separate areas. The diagnosis was confirmed by histological examination of a surgical biopsy and bacteriological examination of a percutaneous aspirate of the collection. Standard anti-tuberculosis treatment was given for nine months with good clinical and radiological resolution. In this case report, we study the anatomical and clinical features of this condition and discuss the diagnostic difficulties.
孤立性胸壁受累是一种非常罕见的结核病形式,多灶性定位更是罕见。它常常给诊断带来难题,因为需要通过手术活检来鉴别胸壁肿瘤。我们报告一例胸壁结核性脓肿病例,病变局限于胸壁前部和上部,同时伴有腹部的另一处病变,但无肺部受累。患者为一名56岁女性,胸骨右侧肿胀已有一年病史,数月后腹部右侧又出现一处肿胀。影像学和生物学检查显示在两个不同部位存在胸壁肿瘤。手术活检的组织学检查以及对脓肿穿刺液的细菌学检查确诊了该病。给予标准抗结核治疗九个月后,临床和影像学表现均得到良好改善。在本病例报告中,我们研究了这种疾病的解剖学和临床特征,并讨论了诊断难点。