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Pulmonary puzzle
Man with chest wall mass and hypotension
  1. Che-Yu Guan1,2,
  2. Cheng-Hsuan Ho1,
  3. Yi-Jhih Huang3,
  4. Hong-Hau Wang4,
  5. Ying-Yi Chen3,
  6. Chia-Hsin Liu1,5
  1. 1 Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  2. 2 Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
  3. 3 Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  4. 4 Department of Radiology, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan
  5. 5 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  1. Correspondence to Dr Chia-Hsin Liu, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; arron12182012{at}gmail.com

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Case presentation

A 59-year-old man with a history of encephalopathy in bedridden state since childhood presented to our hospital with a left-sided enlarging chest wall mass of a 2-month duration. On physical examination, his vital signs were as follows: temperature, 35.8°C; pulse rate, 54/min; respiratory rate, 28/min; and blood pressure, 79/39 mm Hg. He displayed a tender, erythematous, fluctuant mass (9×8 cm) over the left anterior chest (figure 1A) and tenderness in the left upper quadrant. Moreover, poor dentition was noted. The laboratory studies showed leucocytosis (17.5×109/L) with predominant neutrophil count (88%) and elevated C-reactive protein level (164.8 mg/L). Chest radiography revealed an opacification extending from left lower lung field to left subphrenic region and blurred left costophrenic angle (figure 1B). Ultrasonography of the chest wall mass presented fluid collections with the communication between the chest wall and the pleural cavity …

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Footnotes

  • Contributors C-YG and C-HL wrote the manuscript. Y-JH and Y-YC treated the patient. C-HH and H-HW performed and interpreted imaging studies.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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