The Cardiovascular Physical Examination - Is It Still Relevant?

Advances in technology have reshaped the practice of medicine. These changes have greatly benefited our patients. However, in the setting of these advances, the importance of basic clinical tools is more pertinent than ever. Despite the growing reliance on technology, the physical exam remains valuable and cost effective, often enabling the well-trained clinician to arrive at the diagnosis, rapidly and accurately. The physical exam must not become a relic of a distant past. We aim to investigate current competency and proficiency, proposals for change in teaching curriculums, and the relationship with technology such as hand-held echocardiography. A skillful exam provides both emotional and intellectual satisfaction. It may be a lost art but it is well worth the effort to restore.

Spindle-cell sarcoma of the popliteal fossa mimicking a benign vascular lesion.

Spindle-cell sarcomas are a group of aggressive malignant soft-tissue tumors with diverse clinical presentations. While some of these tumors may represent de novo malignant transformation of benign entities, others may present with a long indolent course before their invasive nature is apparent. We report the case of a previously healthy 73-year-old female with spindle-cell sarcoma of the left popliteal fossa who initially presented with a painless mass of several months' duration. Magnetic resonance imaging (MRI) suggested a benign vascular lesion/venous angioma, but after the patient's clinical course changed, repeat MRI 18 months later was consistent with an infiltrative soft-tissue malignancy/sarcoma. Excisional biopsy revealed a stage II spindle-cell sarcoma. The patient then underwent radiotherapy and subsequent above-the-knee amputation. Three years following the amputation, the patient is free of local tumor recurrence or metastatic disease.