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JAMA Clinical Challenge
June 18, 2014

Lung Opacification

Author Affiliations
  • 1Department of Pediatrics, Inova Children’s Hospital, Inova Fairfax Medical Campus, Falls Church, Virginia
  • 2Department of Pathology, Inova Children’s Hospital
JAMA. 2014;311(23):2434-2435. doi:10.1001/jama.2013.286226

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 1) shows left lower lobe opacification obscuring the left hemidiaphragm and blunting of the left costophrenic angle.