Abstract
<h3>History</h3> An 18-year-old woman was admitted to the hospital with a history of sudden onset of dyspnea, cough, fever, and pain in the left hemithorax. A posteroanterior roentgenogram of the chest (Fig 1) showed a large pleural effusion on the left side. A suggestive mass lesion was observed in the area of the aortic arch, projecting laterally into the left hemithorax. Gross alteration in the bony architecture of the left scapula and uppermost segment of the left humerus was identified, reflecting the presence of confluent, osteolytic lesions in these structures. The left clavicle also was affected. A left-sided thoracentesis was performed; 2,500 mL of chylous fluid was obtained. A posteroanterior roentgenogram of the left shoulder area (Fig 2) obtained eight years previously (when the patient was 10 years old) because of an attack of myositis showed similar abnormalities affecting the scapula, again manifested by the presence of multiple, confluent, osteolytic
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