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Not What It Seems

      Sometimes, a seemingly clear sign can point you in the wrong direction. A 74-year-old woman presented with a diagnosis of presumed metastatic breast cancer. Over the previous 3 months, she had experienced increasing abdominal girth, a 15-pound unintentional weight loss, and bilateral swelling of the lower extremities, which was more pronounced on the left side. A vague intermittent burning pain in her lower abdomen often radiated into her groin, but she reported no change in bowel or bladder function. She also complained of tight pressure in both legs with occasional shooting pains into her thighs. In the preceding week, she had noticed increased dyspnea on exertion, even with minimal effort.
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