This kind of progressive, worsening scaly rash affecting the fingers, hands, toes, feet, and ears were witnessed in a 60-year-old woman. She first noticed 8 months ago that her fingernails and toenails were getting dystrophic. Shortly afterwards, her toes, fingers, and distal aspect of both hands and feet became scaly and red. Eventually, her ears were involved with scales and redness. Physical examination Dystrophic changes affecting all fingernails and toenails were noted.
There were scaly, violaceous patches on all fingers, toes, and distal aspect of both hands and feet. She also had scaly, violaceous patches on the helices of both ears. (Images attached) Chest CT Very large mass in the superior mediastinum that appears to arise from the oesophagus. What other tests would have been ordered before proceeding for CT? What could be the diagnosis for this presentation based on this…
