Oncology Patient? Figure 1 History

Ms. G.M. is a 79-year-old woman who was diagnosed with esophageal cancer in June 2008, at which time she under-went neoadjuvant chemoradiation. This was followed by a three-hole esopha-gectomy with a thorascopic right chest dissection in May 2009, with complete pathologic response. Unfortunately, in May 2010 she was found to have a recur-rence on chest CT; a CT-guided biopsy demonstrated metastatic carcinoma. Ms. G.M. underwent a video-assisted thoracic surgery wedge resection, and pathology revealed a squamous cell carcinoma consistent with her prior esophageal cancer. Subsequently, she developed another recurrence in the right upper lobe of the lung with me-diastinal lymphadenopathy consistent with recurrent esophageal cancer. She began systemic chemotherapy with the FOLFOX (fluorouracil, leucovorin, ox-alipatin) regimen. Chief Complaint Following three cycles of FOLFOX, Ms. G.M. presented to the clinic with a chief complaint of shortness of breath as well as facial and arm swelling. The IV team nurses were unable to elicit a blood re-turn from her portacath. Review of Systems Ms. G.M. reported weakness and in-creasing shortness of breath over 2 weeks, as well as intermittent nausea, vomiting, and constipation follow-ing her last cycle of chemotherapy. On physical examination, vital signs were notable for temperature 97.5°F, pulse 89, blood pressure 140/80 mm Hg, re-spiratory rate 18, and O2 saturation of 97 % on room air. Chest exam was nota-ble for bibasilar crackles with evidence of dilated chest veins. Ms. G.M. under-went a vascular flow study (see Figure 1), and a chest CT scan with contrast had been obtained following vascular access placement (see Figure 2)