Man With Chest and Shoulder Pain, Cough, and Mediastinal Mass

June 19, 2013

The 49-year-old patient was admitted after two weeks of cough and hemoptysis culminating in chills, night sweats, and left-sided chest pain radiating to the shoulder. He is hypertensive and diabetic, has a history of retinitis and pan-uveitis, and a pacemaker has been implanted.

The 49-year-old patient was admitted after two weeks of cough and hemoptysis culminating in two days of chills, night sweats, and left-sided chest pain radiating to the shoulders. His medical history includes hypertension, diabetes, chronic rhinitis and sinusitis, and implantation of a pacemaker for heart block.

At the time the heart block was diagnosed, he presented with erythema of the left eye, photophobia, pain, and the sensation that his eyes were “popping out.” An ophthalmology examination showed retinitis and pan-uveitis, but no sign of infection.



The chest CT taken at the latest admission appears above. What does it show?

Can you determine the correct cause of his current chest pain?

Click here to see the diagnosis and case description.