LYMPHEDEMA

Chronic, painless edema, usually of the lower extremities; may be primary (inherited) or secondary to lymphatic damage or obstruction (e.g., recurrent lymphangitis, tumor, after surgical excision or irradiation of regional lymph nodes, filariasis).

PHYSICAL EXAMINATION

Marked pitting edema in early stages; limb becomes indurated with nonpitting edema chronically. Differentiate from chronic venous insufficiency, which displays hyperpigmentation, stasis dermatitis, and superficial venous varicosities.

LABORATORY

Abdominal and pelvic ultrasound or CT or MRI to identify obstructing lesions. Lymphangiography or lymphoscintigraphy (rarely done) can confirm diagnosis. If unilateral edema, differentiate from DVT by noninvasive venous studies (earlier).

Treatment: Lymphedema

(1) Meticulous foot hygiene to prevent infection, (2) leg elevation, (3) compression stockings, and/or pneumatic compression boots. Diuretics should be avoided to prevent intravascular volume depletion.

Outline

LYMPHEDEMAis the Harrison's Manual of Medicine Word of the day!