(BMJ)—A 24-yo Filipino man presented w/ a 1-mo hx of a rapidly growing tender mass on his chest. Exam: vital signs WNL; 7x6-cm smooth, immobile, firm mass over upper sternum, w/ mild erythema, + cervical nodes. CT confirmed the dx. What is it?
Lipoma
Chondrosarcoma
Tuberculosis
Actinomycosis
Lymphoma
You are correct. This is a TB cold abscess of the chest wall due to hematogenous/lymphatic spread from active pulmonary TB. CT imaging showed the pulmonary TB was pleural based, and there was a separate large paraspinal TB abscess. A tuberculin skin test was positive at 48h. The quick growth of the chest wall mass in size and tenderness, w/ associated cervical lymphadenopathy, suggested TB, even though the pt was immunocompetent. TB was especially likely because he was originally from the Philippines, a TB-endemic area. The pt made a full recovery after tx w/ isoniazid, rifampicin, pyrazinamide, and ethambutol.

Emerg Med J 2018;35:586