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Case Records of the Massachusetts General Hospital

Case 26-2013 — A 46-Year-Old Woman with Muscle Pain and Swelling

List of authors.
  • Margaret Seton, M.D.,
  • Carol C. Wu, M.D.,
  • and Abner Louissaint, Jr., M.D., Ph.D.

A 46-year-old woman presented with pain and swelling in her arms and lower legs for 3 weeks. Examination showed swelling and tenderness of the left arm and tenderness in both calves. Chest imaging revealed a mediastinal mass. A diagnostic procedure was performed.

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Funding and Disclosures

This case was presented at the medical case conference.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

No potential conflict of interest relevant to this article was reported.

We thank Drs. Donald Bloch, E. Tessa Hedley-Whyte, and Robert P. Hasserjian for their comments and review of an earlier version of the manuscript; and Drs. William David (Neurology), Michael Lanuti (Surgery), Emily Hyle (Medicine), and Andrew Liteplo (Emergency Medicine) for their assistance with preparation of the case history.

Author Affiliations

From the Department of Medicine, Brigham and Women's Hospital (M.S.), the Departments of Radiology (C.C.W.) and Pathology (A.L.), Massachusetts General Hospital, and the Departments of Medicine (M.S.), Radiology (C.C.W.), and Pathology (A.L.), Harvard Medical School — all in Boston.

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