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Picture quiz: A swelling of the arm

BMJ 2004; 328 doi: https://doi.org/10.1136/sbmj.040259 (Published 01 February 2004) Cite this as: BMJ 2004;328:040259
  1. John W Williams, consultant radiologist1,
  2. Maktoum Azeez, senior house officer1
  1. 1Department of Radiology, Conwy and Denbigshire NHS Trust
  2. 2Department of General Medicine, Conwy and Denbigshire NHS Trust

A GP referred a 73 year old woman with a one day history of sudden painful swelling in her left arm. She was clinically well, and, apart from diffuse swelling of the whole of her left arm, physical examination was unremarkable. Doctors did a number of investigations, including a chest x ray and a computed tomography (CT) scan (figs 1-3).

Questions:

  1. What abnormality is seen in fig 1?

  2. What is the investigation in fig 2? What abnormality can you see?

  3. What abnormalities can you see in the CT scan (fig 3)? What is the likely diagnosis?

Answers

  1. A large superior mediastinal mass causing tracheal deviation and compression.

  2. A film obtained during venography of the left arm. The left subclavian vein has an irregular stricture, and the left brachiocephalic vein is occluded.

  3. The CT of the chest (enhanced with intravenous contrast material) shows enlargement of the right lobe and isthmus of …

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