1 Occhipinti AA, et al. Arch Dis Child Educ Pract Ed 2020;0:1–3. doi:10.1136/archdischild-2020-319658 EPILOGUE Painful thoracic swelling in a refugee teenager Alessandro Agostino Occhipinti, 1 Stefano Di Bella, 1 Ferruccio Degrassi, 1 Gianluca Tornese , 2 Maria Assunta Cova, 1 Egidio Barbi 2 CASE A 14-year-old refugee, escaping from a Middle East war zone, was admitted with a 3-month history of chest pain and a 2-week history of sternal swelling. The patient had no previous medical history, but reported having been beaten by a policeman at a border at the beginning of his journey. He did not have the following symptoms: cough, wheezing fever, weight loss and sweating. When he was admitted to the hospital, he was afebrile; blood pressure was 120/70 mm Hg, pulse 95 beats per minute and oxygen saturation 97% while breathing ambient air. On physical examination, there was a 10 cm fluctuating swelling in the sternal region. The lesion was reddish, warm, tender and painful (figure 1). Digital clubbing was also noticed. The remaining examination was normal. White blood cell count was 9000 cells per mm 3 , haemoglobin 145 g/L, erythrocyte sedimentation rate and C reactive protein were normal as well as renal and liver function tests. ECG was regular. QUESTION 1 Based on the clinical picture, laboratory tests and history, what is the most likely diagnosis? 1. Chest wall tuberculosis 2. Lymphoma 3. Thoracic actinomycosis 4. Infected haematoma QUESTION 2 Which is the best diagnostic test to confirm this diagnosis? 1. Ultrasound scan 2. MRI 3. CT 4. Chest radiograph QUESTION 3 What is the mainstay of the management of this condition? 1. Drainage of the abscess 2. Antitubercular chemotherapy 3. Aspiration of the abscess and antitubercular chemotherapy 4. Hyperbaric oxygen therapy Answers can be found on page 02. Figure 1 Swelling in the sternal region. copyright. on August 25, 2020 by guest. Protected by http://ep.bmj.com/ Arch Dis Child Educ Pract Ed: first published as 10.1136/archdischild-2020-319658 on 24 August 2020. Downloaded from