supraclavicular lymph node swollen gabapentin

#SUPRACLAVICULAR LYMPH NODE SWOLLEN GABAPENTIN SKIN#

1 Cancer tends to spread to long medullary bones since there is more blood supply and the bone marrow provides a fertile microenvironment for the metastatic cancer cells to flourish. Clavicles are long flat bones that have no bone marrow. It is also rare for lung carcinoma to invade the clavicles since it is more commonly found to metastasise to the vertebrae, pelvis, humerus and femur. It is very rare for lung malignancy cases to present with a painful clavicular mass without any respiratory or constitutional symptoms. Our patient was at risk for lung cancer since he was an active smoker and worked in the construction sector, whereby he was constantly exposed to cement and concrete dust. 5 showed that chronic exposure to cement dust increased the risk for lung, laryngeal and gastrointestinal cancer as well as dermatitis. 4 Lung adenocarcinoma is the most common lung malignancy and strongly associated with smoking. Trachea, bronchus and lung carcinoma is the second most common group of cancer among males and the fifth most common among females in Malaysia. The clavicular swelling and pain resolved after two courses of platinum-based chemotherapy. Epidermal growth factor receptor (EGFR) mutations were negative. Our patient was diagnosed with lung adenocarcinoma (stage T1cN3M1). CT-guided biopsy of the right apical mass identified it as primary lung adenocarcinoma. There were also bilateral supraclavicular and mediastinal lymph node enlargements, a right adrenal lesion and lytic lesions of the posterior part of the second right rib that were suggestive of distant metastases. Computed tomography (CT) neck and thorax showed a spiculated right apical lung mass measuring 4.1 x 3.4 x 5 cm ( Figure 2). It revealed a well-defined hypoechoic lesion with cortical destruction at the medial end of the right clavicle, thus raising the suspicion of a tumour or bony metastasis. Ultrasound of the right sternoclavicular joint was performed to determine the origin and extent of the mass. The patient’s poor response to medical therapy raised the suspicion of malignancy.Ī clavicular radiography study showed an irregular margin of the medial end of the right clavicle when compared to the medial end of the left clavicle (red arrow). However, the swelling and pain were not reducing. He was covered with intravenous augmentin (1.2 g) thrice a day for one week whilst admitted.

#SUPRACLAVICULAR LYMPH NODE SWOLLEN GABAPENTIN SKIN#

Tuberculosis workup (tuberculin skin test and sputum for acid-fast bacilli) were negative. The lungs and remaining bones appeared normal. On the chest and clavicle radiographs, the right clavicle had a heterogeneously thickened medial end that was suspicious of a soft tissue lesion or lymph node ( Figure 1). Bilateral upper limb neurological findings were normal. It was immobile and mildly tender on palpation. On examination, there was a firm-to-hard swelling at the right medial part of the clavicle measuring 3x3 cm. Although he previously sought treatment at multiple clinics and was given a few courses of oral analgesics and antibiotics, the pain and swelling were not reducing. There was no history of head or neck radiation, contact with tuberculosis patients or malignancy in his family. Since he was a construction worker, he was constantly exposed to cement and concrete dust. He was an active smoker of 25 pack-years. He also had no cough, dyspnoea, haemoptysis, loss of weight, dysphagia, odynophagia or noisy breathing. He had no recent trauma, fall or traditional massage. A 39-year-old man presented to the emergency department with a complaint of pain and progressively enlarged right medial clavicular swelling with intermittent fever over a 4-month duration.

Supraclavicular lymph node swollen gabapentin