The
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Tuberculous Abscess A
B
C
A
previously healthy 18-year-old man was admitted to the hos- Thomas Troelsen, M.D. pital with a 3-month history of coughing, expectoration of reddish sputum, Ole Hilberg, M.D. weight loss, and fever; a small region of swelling had developed on his ante- Aarhus University Hospital rior chest wall in the preceding week. A computed tomographic (CT) scan of the chest Aarhus, Denmark obtained on admission showed a collar-button abscess (a subcutaneous abscess [email protected] connected to a deeper abscess by a passage), consisting of an abscess in a lymph node in the left mediastinum (Panel A, red arrow) connected to a subcutaneous abscess in the anterior chest wall (Panel A, blue arrow). CT also revealed an extensive parenchymal abnormality in the left upper lobe. A sputum smear showed acidfast bacteria, and a culture grew pansusceptible Mycobacterium tuberculosis. Tests for human immunodeficiency virus were negative. The patient received 8 weeks of standard antituberculous treatment, but the infection progressed, with increased swelling, erythema, and fluctuation of the subcutaneous abscess (Panels B and C). The abscess was subsequently treated with open drainage. Pharmacologic treatment of a tuberculous abscess is seldom sufficient, and open drainage or surgical excision is often required. The patient has been without signs of relapse since surgery but required plastic surgery to improve the cosmetic result after drainage. DOI: 10.1056/NEJMicm1311878 Copyright © 2014 Massachusetts Medical Society.
n engl j med 371;2
nejm.org
july 10, 2014
The New England Journal of Medicine Downloaded from nejm.org at PRINCETON UNIVERSITY on August 11, 2015. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
161
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Tuberculous Abscess A
B
C
A
previously healthy 18-year-old man was admitted to the hos- Thomas Troelsen, M.D. pital with a 3-month history of coughing, expectoration of reddish sputum, Ole Hilberg, M.D. weight loss, and fever; a small region of swelling had developed on his ante- Aarhus University Hospital rior chest wall in the preceding week. A computed tomographic (CT) scan of the chest Aarhus, Denmark obtained on admission showed a collar-button abscess (a subcutaneous abscess [email protected] connected to a deeper abscess by a passage), consisting of an abscess in a lymph node in the left mediastinum (Panel A, red arrow) connected to a subcutaneous abscess in the anterior chest wall (Panel A, blue arrow). CT also revealed an extensive parenchymal abnormality in the left upper lobe. A sputum smear showed acidfast bacteria, and a culture grew pansusceptible Mycobacterium tuberculosis. Tests for human immunodeficiency virus were negative. The patient received 8 weeks of standard antituberculous treatment, but the infection progressed, with increased swelling, erythema, and fluctuation of the subcutaneous abscess (Panels B and C). The abscess was subsequently treated with open drainage. Pharmacologic treatment of a tuberculous abscess is seldom sufficient, and open drainage or surgical excision is often required. The patient has been without signs of relapse since surgery but required plastic surgery to improve the cosmetic result after drainage. DOI: 10.1056/NEJMicm1311878 Copyright © 2014 Massachusetts Medical Society.
n engl j med 371;2
nejm.org
july 10, 2014
The New England Journal of Medicine Downloaded from nejm.org at PRINCETON UNIVERSITY on August 11, 2015. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
161
