ANSWER to A painless chest swelling.

(Refer to page 99)Answer: Tubercular cold abscess. The patient’s chest radiography in the panel across showing right upper zone consolidation.Sputum examination were all negative. Bronchoscopyshowed a mass partially obstructingthe anterior segment of right upper lobebronchus. Biopsy revealed multiple multinucleatedgranulomas and Langhans giantcells with areas of caseation and Acid FastBacilli (AFB) on Zeil-Neelsen staining. Thepatient responded to anti-tubercular treatment(ATT).Ten percent of extra-pulmonary tuberculosis(TB) and one to two percent of totalthe cases of TB are musculoskeletal in origin.Out of all the tubercular cold abscesses,tuberculous spondylitis (cold abscess ofspine) is the most common.1