A 76-year-old woman was referred to our hospital due to further evaluation of anaemia. During the past 3 years, she had been treated for multiple spinal compression fractures with vertebroplasty. Her blood pressure was 90/50 mm Hg, heart rate 75 beats/min, body temperature 37.7°C and respiratory rate 20/min at admission.
On blood sampling, her haemoglobin level was 5.2 g/dL and white cell count and platelet count 3.7 and 22×103/ µL, respectively. She was diagnosed with multiple myeloma after serial diagnostic workups. Because her chest radiography showed cardiomegaly and left-sided pleural effusion with small atelectasis, transthoracic echocardiography and contrast enhanced chest CT were performed (figure 1, see online supplementary video).
Question Which of the following is the most likely diagnosis of the cystic lesion?
- diaphragmatic hernia
- echo-free spaces around the heart
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Contributors JKO made manuscript and images. JHP obtained echocardiographic images and revised the manuscript and images.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Chungnam National University Hospital Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.