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An unusual complication of carcinoma of the caecum
  1. Y Ramkissoon,
  2. H Ghoorahoo,
  3. S F Haydock,
  4. K M O'Shaughnessy
  1. Clinical Pharmacology Unit, Department of Medicine, Addenbrooke's Hospital, Cambridge, UK
  1. Dr K M O'Shaughnessy, Clinical Pharmacology Unit, Addenbrooke's Centre for Clinical Investigation, Box 110, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK (e-mail: kmo22{at}medschl.cam.ac.uk)

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A 64 year old woman presented with loss of appetite, weight loss, and altered bowel habit. A barium enema confirmed the presence of a caecal carcinoma. A liver ultrasound scan was normal and admission for a right hemicolectomy was planned. Three days before the planned admission, she awoke with severe pain in the left gluteal region. Over the next few hours the pain increased in severity and the affected region became swollen and discoloured. She was referred for hospital admission. On arrival at hospital she was apyrexial, with a tachycardia of 120 beats/min but a blood pressure of 140/86 mm Hg. She was noted to have a large (>10 cm) well demarcated area of reddish purple discoloration over her left thigh. Power and reflexes were reduced in the left leg. The area of the lesion spread rapidly and crepitus developed. A surgical opinion was sought. An urgent computed tomogram was requested to determine the full extent of the lesion before surgical intervention. Images were obtained of the pelvic and gluteal region (fig 1) and the thorax (fig 2). The patient remained alert and comfortable during the imaging. Shortly after the scan was completed, however, the patient suffered a cardiac arrest with electromechanical dissociation and died.

Figure 1

Computed tomogram of thigh region.

Figure 2

Computed tomogram of thorax.

Questions

(1)
What abnormality is seen on the computed tomogram in fig1?
(2)
What is the lethal abnormality present on the computed tomogram in fig 2?
(3)
What is the underlying diagnosis and what are the treatment options for this condition?

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