Severe Lower Limbs Lymphedema Following Breast Carcinoma Treatment Revealing Radiation-Induced Constrictive Pericarditis: A Case Report

• Published in: Angiology 2005-01, Vol.56 (1), p.119-121
• Main Authors: Granel, B., Gaudy, C., Serratrice, J., Ene, Nicoleta, Mesana, T., Bonnet, J. L., Lepidi, H., Disdier, P., Piana, L., Weiller, P. J.
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Blood and lymphatic vessels; Breast Neoplasms - drug therapy; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Carcinoma, Ductal - drug therapy; Carcinoma, Ductal - radiotherapy; Carcinoma, Ductal - surgery; Cardiology. Vascular system; Cardiovascular system; Combined Modality Therapy; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Drug toxicity and drugs side effects treatment; Edema, Cardiac - diagnosis; Edema, Cardiac - etiology; Female; Humans; Leg; Lymph Node Excision; Lymphatic Metastasis; Lymphedema - diagnosis; Lymphedema - etiology; Lymphedema - surgery; Mastectomy, Segmental; Medical sciences; Middle Aged; Pericardiectomy; Pericarditis, Constrictive - complications; Pericarditis, Constrictive - diagnosis; Pericarditis, Constrictive - surgery; Pericardium - radiation effects; Pharmacology. Drug treatments; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - surgery; Radiation Injuries - complications; Radiation Injuries - diagnosis; Radiation Injuries - surgery; Reoperation; Toxicity: blood; Vasodilator agents. Cerebral vasodilators
• ISSN: 0003-3197; 1940-1574
• DOI: 10.1177/000331970505600118

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.