A 9-year-old girl presented with a history of fever, cough, weight loss and right-sided chest wall pain for 2 weeks. No improvement was seen after 5 days of antibiotic treatment. Her previous history was not significant and she was HIV negative. She had no known tuberculosis (TB) contacts. She had a BCG vaccine scar on her arm. Mantoux skin test was not performed as it was unavailable.
Examination
On examination, she had dullness to percussion on the right side and had reduced aeration on the right side.Anteroposterior radiograph demonstrates lobulated density with a convex intrathoracic margin along the lateral aspect of the chest with a broad base in keeping with pleural pathology. This is continuous with the lamellar effusion extending to the apex. In addition, there is a well-defined elliptical density in the mid portion of the right chest and no air-bronchogram within it consistent with a ‘pseudotumour’. Lateral radiograph serves to confirm that the elliptical density lies within the major fissure and that it is also pleural based.
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