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A 40-year-old male presented with progressive breathlessness and hoarseness of voice. He denied any history of chest pain, cough, haemoptysis, palpitations or paroxysmal nocturnal dyspnoea. He was a smoker with 10 pack-year of smoking. His medical illness includes long-standing hypertension of 10 years duration controlled with oral amlodipine and atenolol. Previous echocardiography showed dilated and hypertrophied left ventricle with severe systolic dysfunction. At presentation, he was fully conscious with vitals as follows: heart rate 124/min, respiratory rate 34/min and blood pressure 110/70 mm Hg. All peripheral pulses were well felt. Chest examination revealed diminished movement of left hemithorax, reduced vocal resonance and breath sound with shift of mediastinum to right. Posteroanterior chest radiograph showed an opaque left hemithorax and a large retrocardiac opacity (arrows) with contralateral shift of mediastinum (figure 1A). Ultrasonography of thorax showed a large mixed echogenic lesion …
Footnotes
Contributors SS is responsible for planning, conception of idea, collection of images and writing of initial draft. MKP is equally responsible for the conception, design and writing of the manuscript. SB helped in the writing of the manuscript, radiological description, legends for images and involved in the design of the manuscript. PRM has contributed to the writing and critically reviewed the manuscript to its final shape before submission to the journal. All authors were involved in the active management of the patient and have reviewed the final manuscript before submission to the journal. We hereby declare MKP as the guarantor for the overall content of the manuscript.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.