PMC4355600_01
Physical examination: upper left limb edema with visible collateral veins above left clavicle and in the left arm.
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Heart and lung examination revealed no abnormalities (Figure 1).
(a) Chest computed tomography angiogram. Thrombotic obstruction of the left brachiocephalic vein (dashed arrow) with multiple collateral vessels near the left clavicle and in the upper left limb (full arrow). (b) Chest computed tomography angiogram. Extension of the left brachiocephalic vein thrombus into the superior vena cava (full arrow). Collateral vessels are seen adjacent to the left clavicle and in the upper left limb (dashed arrow). (c) Chest computed tomography angiogram. Arterial thromboemboli in the pulmonary arteries (full arrows).
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Chest computed tomography angiogram showed left axillary-subclavian thrombosis with complete obstruction of the left brachiocephalic vein and superior vena cava thrombosis and thromboemboli in the right and left pulmonary arteries (Figures 2(a), 2(b), and 2(c)).
(a) Abdominal computed tomography. Circumferential thickening of the ascending colon wall (full arrow), multiple mesenteric lymphadenopathy, and thickening of the mesenteric fat (dashed arrow). (b) Abdominal computed tomography. Stranding of the pericolic fat of the ascending colon (full arrows) and lymphadenopathy conglomerate adjacent to the right anterior pararenal fascia (dashed arrow).
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Abdominal computed tomography was performed and showed circumferential thickening of the ascending colon wall; lumbar, aortic, and mesenteric lymphadenopathy with an adenopathy conglomerate near the ascending colon and thickening of the mesenteric fat, without evident abdominal vascular thrombosis, were shown by the angiogram (Figures 3(a) and 3(b)).
Colonoscopy. Friable and bleeding tumor in the colon hepatic flexure, obstructing the lumina.
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(a) Colon hepatic flexure tumor biopsy. Moderately differentiated adenocarcinoma of the colon hepatic flexure (hematoxylin and eosin staining, x100). (b) Ascending colon tumor biopsy. Undifferentiated carcinoma of the ascending colon (hematoxylin and eosin staining, x100).
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