Tuberculous cold abscess usually presents as soft swelling and occurs commonly in the neck, axilla and inguinal regions due to the presence of lymph nodes in these regions. But tuberculous cold abscess of the anterior chest wall is quite rare. Also tuberculous cold abscess of the anterior chest wall presenting as an extremely hard and immobile lump is extremely rare and is so far not reported in the literature and hence is reported here. Due to the extremely hard and immobile lump, the lesion was initially thought to be due to carcinoma breast. But after detailed investigations, the lump was finally diagnosed to be due to tuberculous cold abscess. The exact reasons for the extreme hardness and immobility of the lump are discussed here in detail. The role of ultrasonography in distinguishing between solid and fluid filled lesions of the anterior chest wall and in showing clearly the exact anatomical relation of the fluid filled lesion to the breast and ribs is discussed here. The importance of doing incisional biopsy before starting antituberculous drugs and its role in excluding malignancy is discussed here. The importance of doing prompt surgical drainage and complete evacuation of the cold abscess inorder to prevent the disastrous complication of rupture of the cold abscess into the underlying pleural cavity and lungs is also discussed here.