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Nodular pleural thickening in a young woman

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d3758 (Published 12 July 2011) Cite this as: BMJ 2011;343:d3758
  1. Vijay Hadda, senior research associate,
  2. Gopi C Khilnani, professor,
  3. Arvind Kumar, professor,
  4. Amit K Dinda, additional professor
  1. 1All India Institute of Medical Sciences, New Delhi, 110029, India
  1. Correspondence to: V Hadda vijayhadda{at}yahoo.com

A 17 year old girl presented with a history of intermittent low grade fever for the past one and a half months. She also reported loss of appetite and body weight—about 4 kg. She had no history of cough, expectoration, dyspnoea, chest pain, or haemoptysis. No abdominal symptoms, headache, neck pain or stiffness, or alteration in sensorium were seen. She had no history suggestive of connective tissue disease and her occupational history did not suggest exposure to asbestos. She had been diagnosed with lymph node tuberculosis five years ago at another hospital and had received antituberculous drugs for nine months. An abnormality was seen on a chest radiograph (fig 1) so computed tomography of the chest was performed (fig 2). She was referred to us with a working diagnosis of pleural malignancy.

Fig 1 Posterioanterior radiograph of the chest

Fig 2 Computed tomogram of the chest

Physical examination showed mild fever (38oC). Her pulse (90 beats/min) and blood pressure (110/70 mm Hg) were normal. She had no pallor, icterus, or peripheral lymph node enlargement. Examination of the chest showed a dull percussion note and decreased breath sounds in the left infra-axillary area. Examination of the cardiovascular system was normal. Examination of the abdomen found no organomegaly or ascites. The neurological examination was also unremarkable.

Her white blood cell count was normal (8.3×109/L; reference range 4.0-11.0) and erythrocyte sedimentation rate was 77 mm during the first hour (0-20). Results of extensive laboratory testing (infection, immunology, and biochemistry) were otherwise unrevealing. Enzyme linked immunoassay for HIV was negative.

Questions

  • 1 What does the chest radiograph show?

  • 2 What does …

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