Lymphedema

Lymphedema
Synonyms	lymphoedema, lymphatic obstruction
Lymphedema on a 67 year old female
Classification and external resources
Specialty	General surgery
ICD-10	I89.0, I97.2, Q82.0
ICD-9-CM	457.0, 457.1, 757.0
OMIM	153100
DiseasesDB	7679
eMedicine	article/1087313
MeSH	D008209
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Lymphedema, also known as lymphoedema and lymphatic edema, is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system, which normally returns interstitial fluid to the thoracic duct, then the bloodstream. The condition can be inherited or can be caused by a birth defect, though it is frequently caused by cancer treatments and by parasitic infections. Though incurable and progressive, a number of treatments can ameliorate symptoms. Tissues with lymphedema are at high risk of infection.

Symptoms will include swelling, edema, and pain from a multitude of secondary complications (pressure, musculoskeletal disorder from asymmetry, restricted blood flow). Most patients will avoid discussing pain for many reasons, so this will require logical thinking or communication skills to assess. In advanced lymphedema, there may be the presence of skin changes such as discoloration, verrucous (wart-like) hyperplasia, hyperkeratosis, papillomatosis, and Ulcer (dermatology).

Lymphedema should not be confused with edema arising from venous insufficiency, which is not lymphedema. However, untreated venous insufficiency can progress into a combined venous/lymphatic disorder. Proper imaging will can identify where the dysfunction is in the system, and is essential in identifying the source before treatment is decided.

Presented here is an extreme case of severe unilateral hereditary lymphedema which had been present for 25 years without treatment:

Comparison of normal and swollen limb

Size of swollen foot, toes underneath

Another view of lymphedemic foot

Foot and leg (held vertically)

Lymphedema affects approximately 140 million people worldwide.

Lymphedema may be inherited (primary) or caused by injury to the lymphatic vessels (secondary). It is most frequently seen after lymph node dissection, surgery and/or radiation therapy, in which damage to the lymphatic system is caused during the treatment of cancer, most notably breast cancer. In many patients with cancer, this condition does not develop until months or even years after therapy has concluded. Lymphedema may also be associated with accidents or certain diseases or problems that may inhibit the lymphatic system from functioning properly. In tropical areas of the world, a common cause of secondary lymphedema is filariasis, a parasitic infection. It can also be caused by a compromising of the lymphatic system resulting from cellulitis.

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Wikipedia