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Correspondence to Dr Animesh Ray, [email protected]
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A 26-year-old man from India with no known prior comorbidities presented with a swelling on the right side of the chest wall below the right breast which had been gradually increasing in size over the last 6 months prior to presentation (figure 1).
He had experienced high-grade fever for 10 days, about 3 weeks after noticing the swelling for the first time. There was no history of chest pain, chronic or recurrent cough, haemoptysis, significant loss of weight or trauma to the chest wall.
He denied any family history of tuberculosis. On probing, he was able to recall an exposure to his university hostel roommate, 4 years ago in 2012, from whom he used to learn to play the flute, sharing the same instrument. The roommate had a history of chronic cough and fever and was later diagnosed to have multidrug resistant (MDR) tuberculosis that year (2012).
Our patient had a body mass index of 15.61 kg/m2, without any significant findings on general physical examination. Chest wall examination revealed a 7.5×4.5 cm fluctuant swelling on the anterolateral aspect of the right side of the chest wall, without any overlying skin changes. The mass was mobile and had a cystic consistency. An expansile cough impulse was also present (video 1)....