A case of rapidly ruptured pericostal tuberculosis from calcified pleural mass

A 25-year-old Chinese man with no medical history of pulmonary tuberculosis visited to a hospital for an evaluation of chest X-ray abnormal findings of routine health checkup. Chest computed tomography (CT) demonstrated chest wall mass surrounded by calcified walls in the right anterior chest wall. Eighteen months later, he found subcutaneous mass lesion in the right hypochondriac lesion, and this mass became painful in 5 days. Therefore he visited our hospital, and his chest CT showed low density mass with thickened calcified walls in the right anterior thoracic space, small amount of right pleural effusion and subcutaneous localized mass. A needle aspiration of the right subcutaneous mass demonstrated that the specimen were all negative for acid-fast bacilli smear, culture and PCR for M. tuberculosis. On the contrary, right pleural effusion showed positive for PCR for M. tuberculosis, in spite of negative results of acid-fast bacilli smear and culture. Pericostal tuberculosis that was progressed by the rupture of old calcified tuberculous empyema in the chest wall was confirmed. Antituberculous chemotherapy, chest tube drainage for right subcutaneous mass and pleural decortication and empyema were successfully performed. Pericostal tuberculosis should be differentially considered when the calcified mass in the chest wall changes its shape.