Bilateral leg edema and difficulty swallowing
This patient’s leg pain was the tip of the iceberg. He also had diminished breath sounds and a cachectic appearance.
A 70-year-old man came to our medical center for treatment of painful bilateral leg swelling that had gotten progressively worse over the past week. He had no significant past medical or surgical history, took an aspirin daily, did not smoke tobacco or drink alcohol, and had not taken any trips recently. He denied any chest pain, dyspnea, or orthopnea, but indicated that he’d been having difficulty swallowing food for the past month.
The patient had a cachectic appearance, diminished breath sounds and dullness to percussion over the right middle and lower lung fields, and pitting edema up to the knees bilaterally.
Lab studies showed a normal brain natriuretic peptide of 16 pg/mL, normocytic anemia (hemoglobin, 9.5 g/dL; hematocrit, 29.6%; and a mean corpuscular volume of 82.6 fL), potassium of 2.4 mEq/L, calcium of 5.4 mg/dL, and albumin of 1.4 g/dL. An electrocardiogram (EKG) revealed a bifascicular heart block, which was not new based on older EKGs. A plain chest radiograph was performed (FIGURES 1A AND 1B).
FIGURE 1
Chest x-rays reveal large mass
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