IPLab:Lab 12:Radiation Fibrosis

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Clinical Summary

This 60-year-old white female had developed retraction of her left nipple six years earlier, at which time breast carcinoma was found. A radical mastectomyA radical mastectomy involves removal of the breast, underlying pectoralis muscles, and axillary lymph nodes. was performed. Examination of the surgical specimens showed metastases in regional lymph nodes and local irradiation was thus administered. Two years later, carcinoma of the right breast was found. Following a modified mastectomy, more irradiation was given. A year later the patient developed recurrences for which chemotherapy (cytoxan and adriamycin) was given. After a two year period without problems, the patient developed decreased exercise tolerance, dyspnea on exertion, shortness of breathShortness of breath is a common clinical manifestation of heart failure., paroxysmal nocturnal dyspnea, and orthopnea increasing in severity over 10 days. Chest examination revealed decreased breath sounds with dullness over the left base. Chest x-ray showed a globose cardiac silhouette and left pleural effusion. A pericardiectomyA pericardiectomy is a surgical procedure in which the pericardial sac is opened, a piece is removed, and the sac is left open. was done because of suspected cardiac tamponadeCardiac tamponade is compression of the heart by an acute accumulation of fluid within the pericardium.; however, the patient died soon after the operation.

Autopsy Findings

There was metastatic carcinoma in the pericardium, chest wall, diaphragm, both lungs, and mediastinal lymph nodes. Severe nonobstructive cardiomyopathy, probably secondary to adriamycin, was found. Areas of pleural thickening with adhesions and interstitial fibrosis were found involving the anterior aspect of both lungs.


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