A Comparison of Clinical Outcomes of Debridement and Biopsy Procedures versus Wide Excision in Chest Wall Tuberculosis Treatment at Teaching Razi Hospital of Rasht during 2006 to 2015 Download PDF

Background: Chest wall tuberculosis (CWTB) is rare and its clinical presentation, may be mistake with a pyogenic abscess or chest wall tumor. A diagnosis and treatment of chest wall tuberculosis (CWTB) is both difficult and controversial. There is not a safe and convenient method for surgical treatment of chest wall tuberculosis. The aim of this study was to discuss on the optimal diagnosis and treatment of (CWTB). Methods: During a 10-year period (2006–2015), 35 cases with chest wall tuberculosis were managed by our team. Patients’ medical records were retrospectively reviewed. After confirming the diagnosis by histopathological examination, patients underwent surgical management with two methods, wide resection with reconstruction and wide debridement Results: There were 29 male and 6 female patients. Patients’ age ranged from 22 to 79 years. Cough was the most common clinical complaint in this study, followed by pain and tenderness, withdrawal of pus and bloody sputum. 21 patients had abscess and 14 patients had a chest wall mass and 8 present with osteomyelitis. Diagnosis confirmed with needle aspiration in 11 patients, biopsy in 15 patients and biopsy+aspiration in 9 patients. Surgical procedure was drainage with debridement in 17 patients, wide resection in 18 patients. Fistula formation were detected in 8 patients after debridement and 1 patient after wide resection (p=0.0002). The median length of stay in debridement group was 4 days and in resection group was 7 days. The recurrence was occurred in 4 cases after debridement and none case after resection. The highest percentage of chest lesions occurred in the anterior (54.3%), lateral (31.4%) and posterior (14.3%). There was no lesion infection in patients with wide excision, while it was observed in debridement group in 11.8% of patients. Tuberculosis medication was used 9 months after debridement and 6 months after resection (p = 0.625). There was no mortality in both groups. Conclusion: chest wall tuberculosis mimics symptoms and signs of chest wall tumors or abscesses. The combination of symptoms and radiographic findings suggests the pathologic diagnosis of tuberculosis. Wide resection and reconstruction are shown to have lower rates of fistula formation. Medical treatment must be started immediately after surgery and resection is a better surgical technique with less complications and recurrence.