Primary Mediastinal B-Cell Lymphoma

Presentation

35M, athlete, no known medical problems.

• (all dates modified for HIPAA, relative time spans preserved for instruction)
• 2023-04-15: Working in the crawl space under his house, developed progressive and eventually severe L arm pain and swelling.
• Went to local ED: LUE DVT, put on rivaroxaban. CTPE: +supraclav LN, o/p f/u recommended.
• 2023-04-20: Called 911 for dyspnea.
• 2023-04-21: OSH obtained cervical LN core bx: paracortical hyperplasia w focal necrosis
• 2023-05-05: OSH ER for f/ns and arthralgia, given amox x5d
• 2023-05-10: Our ER for f/c/ns/n/v, weight loss, chest pain, HA, pruritus.
• CT chest: +mediastinal mass, SVC compression w/o critical stenosis, R pleural effusion