Presentation of Case A 25-year-old man was admitted to the hospital because of mediastinal, hilar, and subcarinal lymphadenopathy and a pericardial effusion. He was well until six months earlier, when pain and stiffness developed in his neck and a physician prescribed a soft cervical collar. X-ray films of the cervical spine showed evidence of muscle spasm and were otherwise normal. The symptoms improved greatly, but he began to experience numbness of the left forearm and to have a nonproductive cough. Four months before entry fleeting chest pains developed, and an x-ray film of the chest, obtained elsewhere, was reported to.
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