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Light chain multiple myeloma occurs in 20% of multiple myeloma cases. Extramedullary dissemination of multiple myeloma is rare and involvement of pleura by it is even more rare. A 40 years old female patient presented with complains of recurrent vomiting for last 2 months and cough with expectoration for last 1 week. Chest X-Ray (PA view) showed a rounded homogenous opacity in mid zone of left lung field. CECT (thorax) showed pleura based soft tissue density mass lesions overlying apicoposterior segment of left upper lobe and lingular lobe with lytic destruction of underlying 2nd rib. Ultrasound scan of abdomen was normal. CT guided FNAC from soft tissue mass lesion of left side revealed atypical plasma cells, some of them were binucleate and few appear pleomorphic. Bone marrow aspiration showed 20% atypical plasma cells. Serum protein electrophoresis revealed a thin discrete band in gamma globulin region, while serum immunofixation electrophoresis showed presence of lambda light chain band only, with absence of kappa band, IgG band, IgM band and IgA band. Patient was diagnosed as a case of lambda light chain multiple myeloma with extramedullary dissemination to pleura presenting as pleural mass.

Internal jugular vein (IJV) thrombosis is an extremely rare vascular disease. It is usually secondary to intravenous drug abuse, prolonged central venous catheterization or deep head-neck infections or trauma. Associated malignancies are uncommon and not well documented in the etiology of IJV thrombosis. A 25-year-old male presented with complains of neck swelling on left side for last 1 month and shortness of breath for last 10 days with no ear or nose complain. Examination of his neck showed swelling along the anterior border of the left sternocleidomastoid muscle. An ultrasound scan of the neck and CECT neck revealed left IJV thrombosis. CECT thorax showed anterior mediastinal mass which on biopsy comes out to be non Hodgkin lymphoma. IV heparin was given for IJV thrombosis and patient was referred to radiotherapy department for further treatment.

As compared to aspergilloma which is usually developed after complication of tuberculosis in India, endobronchial aspergilloma is a rare disease entity. We report a rare case of endobronchial aspergilloma which is presented radiologically as a solitary pulmonary nodule. A 24-year-old male presented to the Department of Tuberculosis and Chest Diseases with moderate to severe hemoptysis for the last three months. Chest X-ray (PA view) showed ill-defined homogenous shadow in the right upper zone. CECT Thorax review showed intrabronchial mass in the posterior segment of the right upper lobe. CT-guided FNAC was performed, which reveals Aspergillus hyphae mixed with sputum and necrotic material, without any evidence of malignancy. Fibreoptic bronchoscopy was done, it reveals a ball-like region, occluding partially, the lumen of the posterior segment of right upper lobe with hyperemia. The ball was movable. Biopsy was performed and it revealed a partially eroded lining of metaplastic squamous epithelium, overline of chronically inflamed granulation tissue and scar intermingled with fungal hyphae. Serological test for Aspergillus precipitin was positive. The ball was removed using forceps and basket. Endobronchial aspergilloma may be present as solitary pulmonary nodule on chest X-ray. Bronchoscopic and endobronchial biopsies are invaluable in the diagnosis of endobronchial aspergilloma.

A 24 years old female was presented with a 2 weeks history of fever (high grade), cough, fatigue, shortness of breath, chest pain right side and low back ache. Patient prefers to lie towards right side. CECT thorax reveals empyema thoracic with paravertebral extension. Patient was put on IV antibiotic according to culture and sensitivity. Clinical and Radiological improvement was evident after 1 week.

A 21-year-old male, presented with dull aching chest pain, shortness of breath. CECT thorax reveals lobulated mediastinal mass containing soft tissue predominantly in superior and anterior mediastinum with a few foci of calcification seen along septae. CT guided FNAC was suggestive of teratoma. The patient underwent surgical resection.

Summary A lung hernia refers to part of a lung pushing through a tear, or bulging through a weak spot, in the chest wall, neck passageway or diaphragm. Lung hernia is a distinctly rare event, regardless of its location and cause. Most lung hernias are acquired traumatic thoracic hernias, most commonly caused by vigorous coughing with a subsequent rib fracture. We report a rare case of lung hernia through the left anterior chest wall in a middle-aged male.