Internal Medicine Quiz-Case 7

Archives Of, Medicine
2008 unpublished
A 49-year old man with a history of melanoma treated with chemo-therapy two years ago, presented to the emergency department with fever, mild abdominal pain and bilateral leg swelling. Leg swelling had started two weeks earlier. He also complained for a persistent cough since last month, though he was a heavy smoker since his 15 years. On examination he had a temperature of 37.8 °C, heart rate 100/ min and blood pressure 130/70 mmHg. Marked bilateral extremity edema involving the thighs was
more » ... the thighs was apparent. There was a slight dilation of the abdomen with a prominent pattern of dilated veins on his trunk (figures 1 and 2). The abdominal examination, although difficult in conduction, demonstrated an enlarged and tender liver with smooth lower margin. Spleen was not palpable. Heart sounds were normal and the chest was clear. Otherwise physical examination was normal. Chest X-ray showed a mass in the right lung. Computed tomog-raphy scan of the abdomen and thorax was conducted. A mass in the right lung was found and therefore a bronchoscopic examination was ordered. CT scan findings of the abdomen are showed in the figures 3 and 4. Bronchoscopy cytology results showed lung squamous cell carcinoma.