Lymphedema - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Lymphedema is a chronic, progressive swelling of tissue with protein-rich fluid as a consequence of developmental (primary lymphedema) or acquired (secondary lymphedema) disruption of the lymphatic system. Extremities are most commonly affected, followed by genitalia.
Most cases are secondary to nematode infection (filariasis), malignancy, or cancer-related treatment.
Typically presents with painless unilateral limb swelling; pitting edema is present in early disease, whereas nonpitting edema is a sensitive but nonspecific finding in advanced disease.
Diagnosis is usually made on clinical grounds and confirmed by lymphoscintigraphy.
First-line treatment involves compression, ranging from static garments to complex massage and pneumatic compression devices. Surgical procedures are reserved for patients refractory to conservative measures and/or with significant morbidity.

Secondary lymphedema: left lower extremity lymphedema after radiation, and lymphadenectomy for Hodgkin lymphoma

From the collection of Dr Arin K. Greene

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Primary lymphedema of the right lower extremity
Secondary lymphedema: left lower extremity lymphedema after radiation, and lymphadenectomy for Hodgkin lymphoma
Lymphoscintigraphy showing dermal back flow and absent uptake of radiolabeled colloid in lymph nodes of left lower extremity consistent with lymphedema

Citations

Key Articles

Brix B, Sery O, Onorato A, et al. Biology of lymphedema. Biology (Basel). 2021 Mar 25;10(4):261.[Abstract][Full Text]
Manrique OJ, Bustos SS, Ciudad P, et al. Overview of lymphedema for physicians and other clinicians: a review of fundamental concepts. Mayo Clin Proc. 2020 Aug 20:S0025-6196(20)30033-1.[Abstract][Full Text]
Executive Committee of the International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. Lymphology. 2020;53(1):3-19.[Abstract][Full Text]
Huang TW, Tseng SH, Lin CC, et al. Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials. World J Surg Oncol. 2013 Jan 24;11:15.[Abstract][Full Text]
Nagase T, Gonda K, Inoue K, et al. Treatment of lymphedema with lymphaticovenular anastomoses. Int J Clin Oncol. 2005 Oct;10(5):304-10.[Abstract]

Other Online Resources

National Lymphedema Network: patient support groups (US)
CDC: Division of Scientific Resources

Referenced Articles

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