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Unusual Presentation of a Case of Upper Limb Lymphedema

Hussein, Hazim, MS, MRCSI*; Burezq, Hisham, BS, MD, FRCSC, FAAP

Plastic and Reconstructive Surgery – Global Open: April 2019 - Volume 7 - Issue 4 - p e2137
doi: 10.1097/GOX.0000000000002137

From the *Babtain Centre of Burn and Reconstructive Surgery, Kuwait

Al Babtain Centre for Burn, Plastic and Reconstructive Surgery, Ibn Sina Hospital, Sabah Health Area, Kuwait.

Published online 1 April 2019.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Hazim Hussein, MS, MRCSI, Babtain Centre of Burn and Reconstructive Surgery, Kuwait City, Kuwait, E-mail:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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I would like to introduce an unusual presentation of a case of upper limb lymphedema post axillary clearance after mastectomy for breast cancer. A 52-year-old woman presented to us with a huge mass in the right arm, which started 4 years post axillary clearance. The mass increased gradually in size. It was well defined, heavy, nonpulsatile, noncompressible, and firm with peau d’orange appearance of the skin originating from the lower pole of the right arm. Her main complaint was heaviness with shoulder and neck pain. Both hand and forearm were moderately edematous. Lymphoscintigraphy revealed complete absence of lymphatic channels in the arm. The mass was resected successfully, and the defect was covered adequately by mobilizing local skin flap. Only 28% of cases of postaxillary clearance will be presented by upper limb lymphedema1 because there is a communication between superficial and deep lymphatics in the side of axillary clearance that may facilitate lymph drainage in these situations, illustrating why some cases are not presenting with lymphedema postoperative.2

Fig. 1

Fig. 1

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Fig. 2

In our case, there is an unusual presentation of lymphedema in terms of isolated huge swelling in the arm which can be explained by the absence of lymphatic system in the arm which was mentioned before.

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1. Peter S. The pathophysiology of lymphedema. 1998;83:American Cancer Society Lymphedema Workshop. 2800.
2. Suami H, Pan WR, Taylor GI. Changes in the lymph structure of the upper limb after axillary dissection: radiographic and anatomical study in a human cadaver. Plast Reconstr Surg. 2007;120:988.
Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.