Diagnostic issues in tuberculosis of the ribs with a review of 12 surgically proven cases

Abstract

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 preoperative 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.