Lymphedema
Lymphedema is chronic tissue swelling from impaired lymphatic drainage, primary (developmental) or secondary (from surgery, radiation, infection, or malignancy). It causes progressive non-pitting edema that involves the toes, and management is decongestive therapy with compression, skin care, and cellulitis prevention, since there is no curative drug.
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What this article covers
- Overview
Definition: lymphedema is chronic, progressive tissue swelling caused by impaired lymphatic transport and accumulation of protein-rich interstitial fluid.
- Epidemiology
Secondary lymphedema is most common; filariasis is the leading cause worldwide.
- Risk factors
Cancer surgery with lymph node dissection and radiation (for example breast cancer).
- Pathophysiology
Impaired lymphatic drainage: developmental hypoplasia or acquired damage or obstruction reduces lymph transport.
- Clinical features
Progressive limb swelling, initially pitting then firm and non-pitting.
- Differential diagnosis
Chronic venous insufficiency: edema with venous skin changes and hemosiderin staining that usually spares the toes, unlike the toe involvement and positive Stemmer sign of lymphedema (Chronic venous insufficiency).
- Diagnosis
Establish clinically by characteristic non-pitting edema with a positive Stemmer sign, using lymphoscintigraphy when uncertain: the diagnostic basis is the clinical picture of progressive non-pitting…
- Management
First-line, complete decongestive therapy: manual lymphatic drainage, multilayer compression bandaging then graduated compression garments, exercise, and meticulous skin care, followed by a lifelong maintenance phase.
- Complications
Recurrent cellulitis and lymphangitis. Progressive fibrosis, disability, and functional impairment.
- Prognosis
Chronic and generally not curable, but well controlled with adherent decongestive therapy.
- Prevention
Skin care and prompt treatment of infection to prevent cellulitis, with antibiotic prophylaxis for two or more episodes of cellulitis per year.
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