Clinical presentation:
Young adult male with backache and enlarged palpable lymph glands in the neck and axillae.

There is a para-spinal shadow separate from the the silhouette of the overlying heart density and without loss of normal lower lobe vessel silhouettes. There is no rib crowding. The centre of radius of the para-spinal shadow lies at the level of a sclerotic 9th thoracic vertebra, which shows some patchy destruction on its left margin. The right margin of the same vertebral body shows irregularity of outline, when compared to other vertebrae. The 10th thoracic vertebra is of lower variable density, but also shows some patchy destruction on its left side, where it joins with the density of the left paraspinal soft-tissue mass.

The body of the 11 thoracic vertebra also appears sclerotic with loss of detail. There is no adjacent mass at this level. Given the retained detail of neighbouring vertebrae, this appearance is probably not the density of sub-diaphragmatic structures.