JAMA Clinical Challenge
Wan-Yee Teo, MBBS, MRCPCH (UK)
Robin Y. Dulman, MD
Tuyethoa Vinh, MD
A 16-year-old girl presents with acute left shoulder pain, left-sided chest pain, and shortness of breath, with a history of intermittent left shoulder and left-sided chest pain for 4 months following a dance recital. She has been treated with analgesia and physiotherapy. She denies fever, cough, orthopnea, weight loss, and appetite change. Physical examination reveals tenderness at the location of the left fifth rib and reduced left chest expansion. There is no chest wall deformity. Chest radiography (Figure) shows left lower lobe opacification obscuring the left hemidiaphragm and blunting of the left costophrenic angle.
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Author Affiliations: Drs Teo (email@example.com) and Dulman are affiliated with the Department of Pediatrics, Inova Children's Hospital, Inova Fairfax Medical Campus, Falls Church, Virginia. Dr Vinh is affiliated with the Department of Pathology, Inova Children's Hospital.