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 radiography revealed bilateral pleural effusions. Thoracentesis was negative for malignant cells. Left arm venogram demonstrated compression of the left subclavian vein and lymphangiogram was consistent with perilymphatic stasis. Computerized tomography and magnetic resonance imaging demonstrated a questionable mass in the left side of the neck. On exploration of the left supraclavicular fossa, a severely fibrotic thoracic duct was encountered as well as a prominent scalene lymph node. Pathological section revealed an adenocarcinoma in both specimens which was positive for keratin and carcinoembryonic antigen. Chemotherapy was begun, however, the patient died 3 months later secondary to a respiratory arrest. This presentation of an adenocarcinoma arising from an unknown gastrointestinal source is unusual. A search should be made to locate the primary site. Prognosis is unclear but presumed poor due to the rarity of this presentation.