On examination, patient was febrile. A soft, fluctuant, reducible,
swelling was noted in front of the manubrium sterni with out any
local signs of inflammation or sinusformation (Fig. 1). Tenderness
was elicited on pressure on the spinous processes of D8-D9 vertebrae.
There was noneurodeficit. Examination of all other system was unrevealing.
Routine hemogram showed anemia (Hb= 8.3gm %) and elevated sedimentation
rate (110 mm at 1st hour). Chest X- rayPA view and right posterior-
oblique view showed a soft tissue density in front of manubrium
with erosion of bonymargin. There was destruction of vertebral bodies
of D 4, 5, 8, 9 along with diminution of joint space. Saggital T1-weighted
M R I scan showed involvement of D4-D5 and D8-D9 vertebral bodies
and intervening discs associated withprevertebral and epidural soft
tissue components. The body of the sternum also showed abnormal
signal intensityalong with adjacent soft tissue intensity (Figs.
2 and 3). Aspiration yielded a yellow, cheesy material which on
Z Nstain showed acid- fast bacilli. Mycobacterium tuberculosis was
grown on culture. Serology for HIV was negative. Adiagnosis of pre
sternal cold abscess was made. Patient was treated with combination
anti tubercular drugs alongwith corset for vertebral lesions. Swelling
subsided gradually and fever responded.
SK Bandyopadhyay, A Moulick J Ghosal, Anita Dutta
Assistant Professor; Post Graduate Student; Professor; Department
of Medicine, Nil Ratan Sircar Medical College andHospital, 138,
A J C Bose Road, Kolkata-700014.
Received : 16.5.2005; Accepted : 15.9.2005