Chest pain and pseudoclubbing in a haemodialysis patient

A 28-year-old lady with end-stage renal failure on intermittent haemodialysis for 6 years complained of a constant right-sided chest pain. She was diagnosed to have Epstein syndrome in childhood characterized by macrothrombocytopathy, nephritis and sensory-neural deafness. The course of her renal failure was complicated by recurrent bleeding diathesis and poor compliance to medications leading to poor phosphate control for prolonged periods. Examination revealed localized rib tenderness and pseudoclubbing of fingers, more marked in index and middle fingers of both hands (Figure 1A, arrows). Hand X-rays revealed severe erosions and resorption of terminal phalanges of fingers (Figure 1B, arrows). CT scan of her chest revealed a localized expansile cystic lesion (osteitis fibrosa cystica,