An Unusual Cause of Calcific Thoracic Metastases

Abstract

An 18-year-old male presented with progressive breathlessness and cough of two months duration. He also complained of generalised body pains, low grade intermittent fever, anorexia and weight loss. He was started on empiric daily anti-tuberculosis treatment with rifampicin, isoniazid, pyrazianmide and ethambutol from elsewhere for right-sided pleural effusion one month ago. He presented to us as he did not experience improvement in his condition. There was no other significant medical history. Physical examination showed a 10cm x 8cm, non-tender hard bony mass with ill-defined margins over the upper third of left arm. There was no evidence of digital clubbing or peripheral lymphadenopathy. Respiratory system examination showed features of a right-sided pleural effusion. InvestigationsRoutine blood and urine investigations were normal. Serum alkaline phosphate levels were elevated (1176 IU/L). Chest radiograph (Figure 1) showed a right-sided pleural effusion with bilateral pleuro-pulmonary calcific lesions. Antero-posterior and lateral radiograph showed bony mass in the upper third of left humerus (Figure 2). Computed tomography (CT) of chest (Figure 3) revealed bilateral pleuro-pulmonary calcifications with right-[