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Author Affiliations: Department of
Surgery, College of Human Medicine, Michigan State University, Lansing
(Dr Bumpers); Department of Surgery, Emory University School of Medicine
(Drs Gabram-Mendola and Rizzo), Department of Surgery, Morehouse School
of Medicine (Dr Okoli), and Georgia Cancer Center for Excellence,
Grady Hospital (Drs Gabram-Mendola, Okoli, and Rizzo), Atlanta.
A 50-year-old African American female patient presented to the
emergency department with a complaint of severe shortness of breath
and a swollen right hand. On admission, she was unable to walk. She
gave no past medical history of diabetes mellitus or of treatments
for other pathologies. A physical examination was significant for
severe edema in the right upper extremity accompanied by excoriation
and necrosis of the skin and soft tissue of the limb and the right
chest wall. A chest radiograph showed a massive pleural effusion with
near complete collapse of the right lung. A photograph of the patient
(Figure 1) and a computed tomographic
scan of the chest (Figure 2) are shown.
Figure 1. Photograph of a 50-year-old
African American female patient at initial presentation.
Figure 2. Computed tomographic scan
of the chest of a 50-year-old African American female patient showing
a massive pleural effusion with near complete collapse of the right
What Is the Diagnosis?
A. Caustic burn injury
B. Locally advanced breast cancer
C. Iatrogenic high-dose radiation
D. Necrotizing fasciitis
Bumpers HL, Gabram-Mendola S, Okoli J, Rizzo M. Image of the Month—Quiz Case. JAMA Surg. 2013;148(3):297. doi:10.1001/jamasurg.2013.316a
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