Pleural-based Mass with Rib Destruction

Abstract

A 23-year-old white woman was admitted to the hospital with a four-month history of left shoulder and left pleuritic chest pain. She had received ibuprofen and chiropractic manipulation without relief. She had no history of trauma, cough, dyspnea, hemoptysis, fever, arthralgias or weight loss. She had no significant past medical history. Her physical examination was totally unremarkable except for obvious left-sided splinting with deep inspiration. There was no chest wall mass or tenderness and no abnormality was detected on auscultation of her lungs. Routine laboratory investigations were normal except for an elevated alkaline phosphatase of 115 μ/ml (normal 20-100 μ/ml). The chest roentgenogram and tomograms showed a pleural-based mass on the left associated with an expansive bone lesion in the third rib (Fig 1 and 2). Bone scan revealed increased uptake only at the area of the lesion in the left third rib. A transthoracic needle aspiration was performed which showed a few red blood cells. Because of the persistent chest pain, thoracotomy was performed. Figure 2 View Large Image Figure Viewer Download Hi-res image