UNILATERAL UPPER EXTREMITY EDEMA - A CASE-REPORT

A case report of a 28 year old Hispanic male with a 5 month history of left arm, face and supraclavicular edema is presented. Chest radiogra phy revealed bilateral pleural effusions. Thoracentesis was negative f or malignant cells. Left arm venogram demonstrated compression of the left subclavian vein and lymphangiogram was consistent with perilympha tic stasis. Computerized tomography and magnetic resonance imaging dem onstrated a questionable mass in the left side of the neck. On explora tion of the left supraclavicular fossa, a severely fibrotic thoracic d uct was encountered as well as a prominent scalene lymph node. Patholo gical section revealed an adenocarcinoma in both specimens which was p ositive for keratin and carcinoembryonic antigen. Chemotherapy was beg un, however, the patient died 3 months later secondary to a respirator y arrest. This presentation of an adenocarcinoma arising from an unkno wn gastrointestinal source is unusual. A search should be made to loca te the primary site. Prognosis is unclear but presumed poor due to the rarity of this presentation.