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Original Articles: General Thoracic

Complete Resection is Mandatory for Tubercular Cold Abscess of the Chest Wall

Department of Thoracic and Cardiovascular Surgery, Clinical Research Institute, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

Accepted for publication August 21, 2007.

^_* Address correspondence to Dr Kim, Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, South Korea (Email: ytkim{at}snu.ac.kr).

Background: Cold abscess of the chest wall is a rare disease and few literature reports detail any treatment experience with a limited patient number. Hence, an optimal treatment plan remains controversial.

Methods: We retrospectively analyzed patients with cold abscess of the chest wall, focusing on their clinical features, surgical results, and the long-term outcome. Eighty patients were enrolled between May 1981 and April 2005. There were 35 male and 45 female patients, who underwent surgical treatment for cold abscess of the chest wall. The mean age of the patients was 31.4 ± 12.5 (14 to 73) years. Forty patients (50.0%) had previous history of pulmonary tuberculosis. A growing chest wall mass was present in every patient. Surgical treatments performed were as follows: abscess debridement and drainage in 15 (18.8%), complete excision of the abscess without chest wall resection in 9 (11.2%), and complete excision of the abscess including chest wall in 56 patients (70.0%).

Results: There were no cases of operative mortality. Operative morbidity developed in four patients; two wound infections, one pneumonia, and one prolonged chest tube drainage. Postoperative antituberculous medication was given to all patients. Twelve patients (15.0%) recurred and required a second operation. The recurrence rate was higher in patients where only drainage of the abscess was performed compared with those in whom complete resection was performed (40.0% vs 9.2%, p = 0.008).

Conclusions: Cold abscess of the chest wall can be surgically managed successfully with low operative risk. Complete resection of the abscess, including a portion of the involved chest wall, is mandatory to avoid recurrence.