A man with abdominal pain
Q1: What does the chest radiograph show (fig 1 in questions, p 741)?
Pathway of steroid hormone synthesis.
The chest radiograph shows a homogenous round opacity in the left upper zone with erosions of the second, third, and fourth ribs.
Q2: What are the findings on computed tomography of the chest (fig 2 in questions; p 741)?
Chest computed tomography reveals erosion of the second, third, and fourth ribs with soft tissue mass in the extrapleural space. In addition there is erosion of thoracic vertebrae. Differential diagnosis includes secondaries in the rib and tuberculosis of the rib with an abscess in the extrapleural space.
Q3: What are the findings on computed tomography of the abdomen (fig 3 in questions; p 741)?
Abdominal computed tomography shows erosion of the lumbar vertebrae, with bilateral thick walled cysts suggestive of bilateral psoas abscess. Aspiration of the abdominal cyst revealed turbid straw coloured fluid with a protein content of 76 g/l. Staining for acid fast bacilli was negative and cytology showed few lymphocytes in an eosinophilic background. At thoracotomy, a tumorous mass (fig 1 below) measuring …
