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Lymphedema

Definition

Lymphedema is painless edema (swelling) of one or both legs due to impairment in the flow of lymph from the leg. It can be a primary or secondary disorder characterized by the accumulation of lymph in soft tissues, caused by inflammation, obstruction, or removal of lymph channels.

Description

Lymphedema may be primary or secondary. The primary type can be present from birth (congenital lymphedema) or may occur during puberty mostly in women(lymphedema praecox), or less frequently later in life (lymphedema tarda). Primary lymphedema occurs less often in men. The patient complains of swelling of the foot, leg, or entire extremity. On examination, the edema is diffuse, causes a typical mound on the dorsum (back part) of the foot or hand, and is only partially pitting (compressible). There are usually no skin changes or evidence of venous insufficiency. Secondary lymphedema is often a result of infection. The onset is explosive, with chills, high fever, toxicity, and a red, hot, swollen leg. Lymphangitic streaks may be seen in the skin, and lymph nodes in the groin are usually enlarged and tender. These features may distinguish it from acute thrombophlebitis (venous inflammation). Secondary lymphedema in older persons may be due to malignant disease in the pelvis or groin. Obliteration of lymphatic tissue by excision or radiation therapy is another cause. When lymphedema is due to infection, the response to antistreptococcal antibiotics is rapid.

Causes

Lymphedema is aggravated by prolonged standing, pregnancy, obesity, warm weather, and the menstrual period.

Symptoms

Lymphedema of the lower extremities begins with mild swelling of the foot and gradually extends to the entire limb. The edema is usually painless and initially may be pitting (compressible). Over time the edema becomes brawny and non-pitting. There is no evidence of ulceration or varicose veins.

Diagnosis

The diagnosis is often made clinically. Lymphangiography and radioactive isotope studies may be useful in defining the specific lymphatic defect.

Treatment

Swelling is treated by elevation or pneumatic compression, and then application of a firm elastic support to be worn while the patient is up. The foot of the bed can be elevated 15 to 20 degrees by placing pillows beneath the mattress. Occasionally, diuretics ("water pills") are helpful. Foot and skin hygiene is necessary to prevent lymphangitis and drying of the skin. Treatment of other symptoms and signs is symptomatic and supportive. Constricting clothing and salty or spicy foods that increase thirst are contraindicated. Surgery may be performed to remove hypertrophied lymph channels and disfiguring tissue as well as to reconnect lymph channels (anastomosis).

Questions

What is the cause? What type of treatment will you be recommending? How successful is the treatment? Will you be prescribing any medication? What are the side effects? Will this recur? Is surgery helpful?

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