Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 12-18: Lymphedema + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Painless persistent edema of one or both lower extremities, primarily in young women Pitting edema without ulceration, varicosities, or stasis pigmentation No ulceration, varicosities, or stasis pigmentation Episodes of lymphangitis and cellulitis +++ General Considerations ++ Primary lymphedema Due to congenital developmental abnormalities of lymphatics Obstruction may be in the pelvic or lumbar lymph channels and nodes when the disease is extensive and progressive Secondary lymphedema involves inflammatory or mechanical lymphatic obstruction due to Trauma Regional lymph node resection or irradiation Extensive involvement of regional nodes by malignant disease or filariasis Secondary dilation of the lymphatics occurs in both forms and leads to incompetence of the valve system, which Disrupts the orderly flow along the lymph vessels Results in progressive stasis of a protein-rich fluid + Clinical Findings Download Section PDF Listen +++ +++ Symptoms and Signs ++ Episodes of acute and chronic inflammation Hypertrophy of the limb Markedly thickened and fibrotic skin and subcutaneous tissue + Diagnosis Download Section PDF Listen +++ +++ Imaging Studies ++ Lymphangiography and radioactive isotope studies may identify focal defects in lymph flow but are of little value in planning therapy T2-weighted MRI has been used to identify lymphatics and proximal obstructing masses + Treatment Download Section PDF Listen +++ +++ Medications ++ No effective cure Antibiotic therapy for secondary infection should cover Staphylococcus and Streptococcus organisms Prophylactic antibiotics have not been shown to be of benefit Diuretic therapy: intermittent courses can be helpful, especially in those with premenstrual or seasonal exacerbations +++ Surgery ++ Amputation for the rare complication of lymphangiosarcoma +++ Therapeutic Procedures ++ Intermittent elevation of the extremity, especially during the sleeping hours (foot of bed elevated 15–20 degrees) Constant use of graduated elastic compression stockings Massage toward the trunk, either manually or pneumatic pressure devices Good hygiene and treatment of any trichophytosis of toes to avoid secondary cellulitis + Outcome Download Section PDF Listen +++ +++ Complications ++ Secondary infection +++ Prognosis ++ Dictated by associated conditions and avoidance of recurrent cellulitis Good with aggressive treatment + References Download Section PDF Listen +++ + +Finnane A et al. Review of the evidence of lymphedema treatment effect. Am J Phys Med Rehabil. 2015 Jun;94(6):483–98. [PubMed: 25741621] + +Haghighat S et al. Comparing two treatment methods for post mastectomy lymphedema: complex decongestive therapy alone and in combination with intermittent pneumatic compression. Lymphology. 2010 Mar;43(1):25–33. [PubMed: 20552817] + +Schaverien MV et al. New and emerging treatments for lymphedema. Semin Plast Surg. 2018 Feb;32(1):48–52. [PubMed: 29636654] + +Torres Lacomba M et al. Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. BMJ. 2010 Jan 12;340:b5396. [PubMed: 20068255]