Abstract
TYPE: Abstract Publication TOPIC: Disorders of the Mediastinum PURPOSE: We describe a 27-year-old male with no past medical history presenting with pleuritic chest pain. The patient was vomiting and while retching, he felt a popping sensation in his substernal chest wall, soon followed by a severe, pleuritic substernal pain. Upon further investigation, he also complained of a 2-month history of early satiety, unintentional weight loss, and night sweats. He had a 10-year smoking history, however, he denied alcohol, illicit drug or steroid use, occupational exposure, recent travel, or a family history of cancer. METHODS: Physical examination revealed substernal tenderness, supraclavicular and axillary lymphadenopathy, and splenomegaly. CBC, CMP, troponin were unremarkable. Chest CTA revealed extensive osteolytic bony destruction with cortical breakthrough of the sternum anteriorly measuring 6.5cm, associated with a pathological sternum fracture. A left third rib fracture was also found. Also noted was a lobulated mass in the anterior right upper lobe, contiguous with mediastinal and right hilar lymphadenopathy. RESULTS: The chest pain was attributed to the sternum and rib fractures and managed conservatively. Auto-immune and malignancy-related investigations were unremarkable. Left axillary lymph node excision biopsy showed nodular sclerosis classical Hodgkin lymphoma. CONCLUSIONS: Despite the 2-month history of B symptoms described by our patient, he initially presented only due to the severe, sudden pleuritic chest pain caused by the pathologic osteolytic sternum and rib fractures. Our patient had no other identifiable cause for the fractures. CLINICAL IMPLICATIONS: Although pathologic fractures in lymphoma are not uncommon, upon review of the literature, Hodgkin lymphoma presenting with a pathologic sternum fracture appears to be extremely rare. DISCLOSURE: No significant relationships. KEYWORDS: hodgkin lymphoma, Pathologic sternum fracture
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