DESCRIPTIONA 65-year-old man presented with left lower chest pain for 2 months and low grade intermittent fever for 1 month. Pain was dull aching, more marked during movement and partially subsided after taking non-steroidal anti-infl ammatory drugs. Examination revealed anaemia and tenderness in left fourth, fi fth ribs, intercostal space in the mid axillary line. All other clinical examinations were normal. Investigations revealed complete blood count: Hb-7.1 g/ dl, erythrocyte sedimentation rate (ESR) -140 mm in fi rst hour, peripheral blood fi lm -normocytic normochromic anaemia with marked rouleaux formation. Chest x-ray revealed a mass of the left chest wall with rib destruction suggestive of malignant pleural mesothelioma. A CT scan ( fi gures 1 -3 ) showed a spindle shaped 4×6 cm tumour, localised at the lateral angle of the fourth, fi fth rib and growing intrathoracic, with destruction of the fourth rib. The mass was relatively well demarcated and there were no cystic components. There was no evidence of lung or lymph node metastasis. CT-guided fi ne-needle aspiration of the chest wall mass showed an increasing number of plasma cells. With these clinical contests our next investigation of choice was bone marrow examination, which revealed marrow was infi ltrated with around 90% of both typical and atypical plasma cells including plasmablast. We therefore diagnosed this tumour as multiple myeloma (MM). Chest pain is a very unusual presentation of multiple myeloma. Isolated chest wall mass without any other skeletal involvement is even rarer. MM often produces gross sternal expansion, distortion and vertebral body
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