Question 15.2

The image below is of a 76-year-old lady who presents with dyspnoea

(The college did not include a picture. A suitable replacement image has been found by Google search, and the source file can be viewed here. )

  • List three abnormalities on observation.
  • What are two likely causes of her dyspnoea?

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College Answer


Previous Right mastectomy

Marked erythema left breast and anterior chest wall on right

2 Ulcerated lesions on the anterior chest wall near the axilla

Ectatic vessels of chest wall


Radiation induced tissue injury with radiation induced pulmonary fibrosis

Superimposed Infection

Tumour recurrence / lymphangitis carcinomatosis


Sorry people; I could find no image with ectatic vessels. It is difficult to add anything more to the college answer. One could also consider direct tumour invasion of the chest wall and pleura, superior vena cava obstruction by metastasis, and pleural effusion (it is surprising that the college did not come up with that one, as it is the most likely cause of dyspnoea in the cancer patient). Pulmonary embolism would also have to be on the list.