Lymphedema

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Background

  • Lymphedema is due to abnormal accumulation of interstitial fluid and fibroadipose tissue.
  • Occurs with lymphatic load exceeds capacity in the lymphatic system

Etiology

Primary

  • Congenital Lymphedema (6-12%) - before age 2
  • Lymphedema Precox (77-94%) - at onset of puberty
  • Lymphedema Tarda (11%) - after age 35

Secondary

  • Cancer and cancer treatment (Lymphadenectomy, Radiotherapy)
    • Breast Cancer - most common
    • Sarcoma
    • Lower Extremity Melanoma
    • Gynecologic Cancer
    • Genitourinary Cancer
    • Head and neck cancer
  • Infection
    • Lymphatic Filariasis
    • Tuberculosis
    • Recurrent Skin Infections (eg. Cellulitis, Erysipelas)
    • Lymphadenitis
  • Obesity
  • Inflammatory disorders
    • Dermatitis
    • Sarcoidosis
    • Arthritis
      • Rheumatoid Arthritis
      • Psoriatic Arthritis
      • Juvenile Idiopathic Arthritis
    • Dermatitis

Clinical Features

  • Slowly progressive swelling
  • Feeling of heaviness, tightness, or discomfort
  • May be pitting at onset
  • Dermal thickening with skin becoming dry, firm, and hyperkeratotic
    • Occurs due to cutaneous fibrosis and adipose deposition.
  • Stemmer Sign - positive if unable to pinch and lift skin at the base of second toe or finger.

Differential Diagnosis

  • Venous Insufficiency
  • Acute deep vein thrombosis
  • Post-thrombotic Syndrome
  • Limb Hypertrophy
    • Hypertrophy of soft tissue or bone (Klippel-Trenaunay syndrome)
    • Overgrowth of body part (Proteus Syndrome)
  • Myxedema
  • Lipedema
  • Tumor

Evaluation

Management

Disposition

See Also

External Links

References