Large pleural effusion as atypical presentation of extraosseous osteosarcoma of the rib

Chest wall tumors occurring during childhood and adolescence present a wide spectrum of diversity and can manifest at any point from infancy to late adolescence. Rib osteosarcoma in adolescents is extremely rare. In this article, we are reporting a case of a nineteen year old male patient presenting with dyspnea. Computed tomography of the chest showed a large tumor of the fourth rib associated with a large pleural effusion. Chest tube was inserted at presentation, studies showed a transudative effusion. Core biopsy was taken from the tumor and the patient was diagnosed with osteosarcoma of the forth rib. He received high dose methotrexate as induction therapy, his course of hospitalization was complicated by death due to septic shock after induction. Publishing such cases is important, not only to document rare presentations, but also to remind clinicians to keep rib osteosarcoma in mind when adolescents present with chest wall masses and unexplained effusions.