case_images: PMC6837769_01
case_images: Frontal chest radiograph (CXR): (a) Initial CXR on presentation demonstrates complete opacification of the left hemithorax with resultant mediastinal shift to the right and cut-off of the left main bronchus (black arrow); (b) CXR post left chest wall/pleural biopsy. Left pneumothorax (white arrow) with the left intercostal drain in-situ (black arrow). Associated surgical emphysema of the left chest wall (white stars).
case_images: SAJR-23-1733-g001.jpg
case_images: PMC6837769_01_SAJR-23-1733-g001.jpg
case_images: F0001
case_images: This was associated with a cut-off of the left main bronchus and mediastinal shift to the right (Figure 1a and b).
case_images: (a-c) Axial, sagittal and coronal contrast-enhanced computed tomography images demonstrate left pleural-based masses which enhance heterogeneously (solid black arrows) with patchy hypodense regions suggestive of necrosis. There is an associated large complex left pleural effusion (white star), atelectasis of the left lung and mediastinal shift to the right. There were no associated intra-tumoural calcifications. Figure 2A - Note the extra-thoracic extension of the mass anteriorly via the intercostal spaces (white arrow) and another pleural-based mass that is inseparable from the pleural pericardial reflection (broken black arrow).
case_images: SAJR-23-1733-g002.jpg
case_images: PMC6837769_01_SAJR-23-1733-g002.jpg
case_images: F0002
case_images: A computed tomography (CT) scan of the chest with intravenous contrast agent demonstrated multiple ill-defined enhancing left pleural-based masses, with patchy hypodense areas (Figure 2a-c). These pleural-based masses were locally invasive, as evident by the poor planes of separation between the pericardium (Figure 2a), descending thoracic aorta (which was shifted to the right of the vertebral column), and diaphragm. The extra-thoracic extension was also noted anteriorly via the intercostal spaces (Figure 2a).
case_images: Axial computed tomography image of the chest on bone window demonstrates the absence of associated bony erosions (white arrow).
case_images: SAJR-23-1733-g003.jpg
case_images: PMC6837769_01_SAJR-23-1733-g003.jpg
case_images: F0003
case_images: There were no associated erosions of the adjacent ribs (Figure 3) nor extension of the mass into the vertebral canal.