Pleural stone or thoracolithiasis is a very rare condition with only 16 cases treated by surgery reported in the literature. We report the case of a 66-year-old patient in whom the pleural stone was thought to be a posterior mediastinal tumor. Exploratory thoracoscopy revealed a 1.5-cm "pearl"-like lesion in the pleural cavity that was easily removed, with an uncomplicated postoperative outcome. As thoracic surgeons, we have to consider this condition in the differential diagnosis of a pleural, lung or mediastinal nodule.
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