title: [Rare cause of a chest pain].
abstract: METHODS
  A 42-year-old woman was admitted because of a newly perceived pain localized in the ventral part of the fifth left rib. The physical examination was normal except for a palpable nodular thyroid and pain on palpation of this rib. The patient history contained a serious car accident and severe cigarette abuse.
  
  
  METHODS
  The chest x-ray in "bone technique" showed an osteolysis in the fifth left rib, which was confirmed by computer tomography and bone scan. The high resolution CT scan of the lung revealed a discrete interstitial reticular pattern with minor cystic alterations without lymph node enlargement.
  
  
  METHODS
  Transbronchial biopsy, bronchoalveolar lavage and a malignancy screening did not lead to a diagnosis. Therefore, the patient was submitted to partial rib resection and open lung biopsy. Histological examination revealed a Langerhans cell histiocytosis. The initial therapeutic approach was a strict smoking cessation.
  
  
  CONCLUSIONS
  The differential diagnosis of a lytic bone lesion in a heavy smoker should include Langerhans cell histiocytosis. On smoking cessation a remission of the disease may be achieved.
authors.affiliation: Medizinische Klinik I des Klinikums Grosshadern, Munich.
authors.forename: I
authors.initials: I
authors.lastname: Ding
authors.forename: I
authors.initials: I
authors.lastname: Bittmann
authors.forename: C
authors.initials: C
authors.lastname: Becker
authors.forename: J
authors.initials: J
authors.lastname: Behr
mesh_terms: D000328:Adult; D001706:Biopsy; D002637:Chest Pain / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006646:Histiocytosis, Langerhans-Cell / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008168:Lung / Q000473:pathology; D010014:Osteolysis / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D013902:Radiography, Thoracic; D012272:Ribs / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D014057:Tomography, X-Ray Computed