Uncommon cause for chest pain

Description

A man aged 26 years presented with pain in the left side of the chest for 9 months, which was increasing on respiration and movement. However, patient did not have exertional dyspnoea, fever, skin lesions, history of trauma, weight loss or loss of appetite. On examination, patient had localised tender swelling on the lower part of left side of the chest with no other bony deformity or facial asymmetry. Chest X-ray posteroanterior view (figure 1) revealed radioluscent expansile lytic lesion in the left eighth rib. Clinical biochemistry revealed an elevated alkaline phosphatase at 224 U/L (normal: 40–125), calcium 9.5 mg/dL (normal: 8.3–10.4), phosphate 4 mg/dL (normal: 2.5–4.6) and 25-hydroxyvitamin-D 28 ng/mL (normal: 30–75). Tc⁹⁹m-labelled methylene diphosphonate bone scan (figure 2) revealed increased tracer uptake only in the left eighth rib. The biopsy of the affected rib was performed which on histopathological examination (figure 3) showed irregular...

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