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A 24-year-old woman presented to hospital with a 3-day history of right-sided chest pain and worsening shortness of breath. On examination, stony dullness of the right side of the chest was noted. Blood tests showed raised inflammatory markers (erythrocyte sedimentation rate 87 mm/hour, C-reactive protein 338 mg/L), but the remainder of the investigations were unremarkable. A chest radiograph was reported as showing a large right-sided pleural effusion with atelectasis of the right lower lobe (figure 1A), with a recommendation for percutaneous drainage by the radiologists. A percutaneous pleural pigtail catheter was inserted, but only 200 mL of fluid was drained; this showed reactive mesothelial and inflammatory cells, but no evidence of malignancy and negative cultures. A CT scan of the chest subsequently revealed a 21×16 cm cyst almost filling the right hemithorax (figure 1B–D). The patient was discussed at the multi-disciplinary team …
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