Clinical presentation

A 21-year-old man was admitted to our hospital due to right chest pain and shortness of breath on exertion for 2 months; the symptoms had been exacerbated for 4 days. He denied having cough, sputum production, chill, fever, night sweats or a history of surgery or trauma. His past history was unremarkable. On physical examination the right lung was dull on percussion and the respiratory sounds from the right inferior lung disappeared on auscultation.

A chest CT scan revealed moderate right pleural effusion; no solid lesion was identified in the lung and there were no enlarged lymph nodes in the mediastinum (figure 1); 3-D reconstruction revealed destruction of the first to fourth ribs, as well as the middle lower part of the right scapula (figure 2).