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Secondary Lymphoedema — RACP Adult Medicine MCQ

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ModerateRheumatologySecondary LymphoedemaRACP Adult Medicine

A 60-year-old woman who had axillary lymph node dissection for breast cancer 5 years ago presents with progressive non-pitting oedema of the left arm. The skin is thickened and fibrotic (peau d'orange appearance). There is no evidence of cancer recurrence on imaging. The right arm is normal. What is the mechanism of oedema?

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Correct answer: C — Lymphatic obstruction

Unilateral non-pitting oedema with skin thickening (peau d'orange) of the arm ipsilateral to axillary lymph node dissection is secondary lymphoedema. Disrupted lymphatic drainage causes protein-rich fluid accumulation in the interstitium, leading to chronic inflammation and fibrosis. Treatment: complete decongestive therapy (manual lymphatic drainage, compression bandaging, exercise, skin care). Diuretics are NOT effective for lymphoedema. Risk of cellulitis requires prompt antibiotic treatment.

Reference: eTG Dermatology – 2024 – Lymphoedema; ALA 2024