Orthopaedic Case of the Month: A 25-Year-Old Man with a Paramedian Painful Lump over the Anterior Chest Wall

Excerpt

A 25-year-old Indian man presented with a swelling of 3-weeks duration over the anterior aspect of his left chest (Fig. 1). The swelling was painful and associated with intermittent low-grade fever. It was insidious in onset and gradually progressive in size. There was no history of cough, hemoptysis, recent weight loss, anorexia, pruritus, seizures, or similar swellings elsewhere in the body. The swelling was not associated with any preceding history of trauma. His medical and family histories were noncontributory. The patient had visited a primary care physician who made the provisional diagnosis of muscular cysticercosis and referred the patient to our institution. On examination, the patient’s vital signs were stable and there was no evidence of lymphadenopathy. His physical status was good. Local examination revealed a tender 5-cm × 3-cm hemispheric fluctuant mass located over the left lower chest wall anteriorly near midline. Its margins were not well defined. Local temperature was increased. The overlying skin was freely mobile and there were no scars or sinuses. On attempted contraction of the upper abdominal muscles, there was no change in the size of the swelling; however, its side-to-side mobility became restricted, suggestive of a swelling arising in the muscle. The rest of the organ systems (respiratory system, abdomen, nervous system) appeared normal on clinical examination.

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