CHRONIC ABSCESSES AND SINUSES OF THE CHEST WALL

Abstract

The subject of chronic abscesses and sinuses of the chest wall has been discussed, with emphasis placed on the treatment of the costal chondritis and sternal osteomyelitis usually associated. A group of nine illustrative cases has been used as a text. In eight of the nine cases the lesion was apparently tuberculous in origin and in several instances tuberculous mediastinal lymph nodes were demonstrated and excised at operation. Lymphadenitis is probably the usual primary focus of infection in these tuberculous cases. In one case the infection was a pyogenic one, secondary to drainage of a sub-diaphragmatic abscess. Costal chondritis must be treated by excision of all cartilage, infected or not infected, which has been exposed in the contaminated operative field. Sternal osteomyelitis may he treated less radically than chondritis; that is by re-section limited to that portion of bone involved by the infection. If careful excision of all infected soft tissue is accompanied by treatment of the associated chondritis and osteomyelitis in the manner suggested above, primary closure of the wound may be practiced in most instances. Antibiotics, especially streptomycin in tuberculous infections, are an adjunct to operative treatment of these abscesses and sinuses but in our hands have not proved a substitute for surgery. Healing has been obtained in all cases of the group. A much longer follow-up period will be necessary to establish the permanency of the initial gratifying results.