Painless Swelling of the Left Lower Extremity and Pitting Edema in a Nonagenarian
A 91-year-old man with a medical history significant for atrial fibrillation, osteoarthritis, degenerative joint disease with bilateral hip replacements, and coronary artery disease presented to a clinic with a 2-month history of progressive painless swelling of the left lower extremity. The physical examination revealed severe edema that extended to the hip. There was, however, excellent capillary refill in all extremities, with some scattered ecchymosis (<2 cm in diameter). Swelling and pitting edema were noted in the patient’s left lower extremity (Figure 1); his right lower extremity was more deeply pigmented. He had no fever, chills, or night sweats, and he had not lost any weight. The patient’s hemoglobin level was 9.5 g/dL. His platelet count, prothrombin time, partial thromboplastin time, and creatinine blood level (1.0 mg/dL) were all normal. Doppler ultrasonography was negative for deep vein thrombosis, but a computed tomography (CT) scan of the abdomen revealed a mass >20 cm in diameter adjacent to the left pelvic sidewall (Figure 2). The patient had undergone multiple different biopsies for the same mass over a period of 10 years, but had not consistently followed with one physician over that time period.
Based on the case description, photograph, and CT scan above, what is your diagnosis?
A. Pelvic abscess
B. Soft tissue sarcoma
E. Non-Hodgkin’s lymphoma
G. Hodgkin’s disease
Answer and Discussion on next page