Severe lower limbs lymphedema following breast carcinoma treatment revealing radiation-induced constrictive pericarditis--a case report.
In patients treated for breast carcinoma, unilateral lymphedema of the upper limb is usual. However, to the authors' knowledge, lower limb lymphedema has never been reported as a complication of breast carcinoma therapy. They report here the first case of a radiation-induced constrictive pericarditis revealed by severe lower limbs lymphedema. A 60-year-old woman was treated for left breast carcinoma with quadrantectomy, axillary lymphadenectomy, and combined radio chemotherapy (60 grays). Three and a half years later she suffered from a diffuse and increasing lower limbs lymphedema, which became huge and disabling. Radiation-induced constrictive pericarditis was evidenced by right cardiac cavities catheterization. A dramatic improvement was rapidly obtained after pericardectomy. Histopathologic analysis of the pericardium did not reveal neoplastic cells. Radiation-induced constrictive pericarditis is usually responsible for lower limbs edema, but lymphedema is exceptional. This case highlights the need to search for a constrictive pericarditis also in the case of lower limbs lymphedema, particularly in a patient treated with mediastinal radiotherapy or combined radio chemotherapy.
Granel
B
B
Service de Médecine Interne, CHU Timone, Marseille, France.
Gaudy
C
C
Serratrice
J
J
Ene
Nicoleta
N
Mesana
T
T
Bonnet
J L
JL
Lepidi
H
H
Disdier
P
P
Piana
L
L
Weiller
P J
PJ
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D044584:Carcinoma, Ductal / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D004489:Edema, Cardiac / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D007866:Leg; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D015412:Mastectomy, Segmental; D008875:Middle Aged; D010492:Pericardiectomy; D010494:Pericarditis, Constrictive / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D010496:Pericardium / Q000528:radiation effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D011832:Radiation Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation