A case of thigh swelling in a patient with metastatic breast cancer receiving combination chemotherapy

Abstract

and significant tenderness on palpation. Doppler examination was negative for deep vein thrombosis (DVT), and X-ray showed no change in the known sclerotic femur lesion. Physical therapy for presumed lymphedema was initiated, along with analgesics, and her chemotherapy was continued. The pain and swelling worsened significantly over the subsequent 3 weeks and required escalation of the dose of narcotic anal-gesic, though these symptoms were noted by the patient to wax and wane without appreciable pattern. A magnetic resonance imaging (MRI) of the thigh was performed. This showed, consistent with the clinical examination, diffuse circumferential subcuta-neous edema, and skin thickening. The rectus muscle was diffusely swollen and edematous, with sur-rounding fluid. In addition, there was the impression of a 1.0 cm (cid:1) 3.5 cm mass in the muscle, demon-strating rim enhancement with central hypointensity, worrisome for necrotic metastasis or abscess. An ultrasound was done to rule out abscess and to aid in a tissue diagnosis. However, this revealed only