Lymphedema

Lymphedema



Definition of Lymphedema 

Lymphedema is a local swelling and fluid retention due to deranged or damaged lymphatic system. It is also known as lymphatic obstruction. In normal conditions, the interstitial fluid is returned to the blood through the thoracic duct, and when this interstitial fluid cannot drain back into the blood, lymphedema occurs. Lymphedema increases the risk of infection in the tissues involved.

 

Cause of Lymphedema

 

Lymphedema can occur either due to some inherited condition (primary lymphedema) or injury to the lymphatic system (secondary lymphedema).

Primary lymphedema is a rare condition in which there is defective development of lymphatic vessels:

  • Milroy’s disease (congenital lymphedema) causes abnormal development of lymph nodes.

  • Meige’s disease (lymphedema praecox) is a condition in which valves are not formed in the lymphatic channels which prevent the fluid from flowing backwards. It usually occurs in childhood.

  • Late onset lymphedema (lymphedema tarda) is rare and develops usually after 30 years of age.

Secondary lymphedema is caused by some other disease that injures the lymphatic vessel and includes:

  • Surgery of lymph nodes or lymph vessels

  • Radiotherapy for cancer

  • Cancer

  • Infection

 

Signs and Symptoms of Lymphedema

These include:

  • Feeling of heaviness

  • Edema

  • Aching pain

  • Discoloration of skin

  • Verrucous (wart-like) hyperplasia

  • Hyperkeratosis

  • Papillomatosis

  • Deformity of leg or involved area, e.g. elephantitis

Risk Factors for Lymphedema

Risk factors of lymphedema are usually the procedures that are done for the removal of lymph nodes. These are as follows:

  • Axillary node removal

  • Sentinel node biopsy

  • Obesity

  • Extent of local surgery

  • Radiotherapy of a local area

  • Delayed wound healing

  • Lymphatic obstruction due to tumor

  • Scarring of the subclavian lymphatic vessels due to surgery or radiation

  • Tumors in the pelvic or abdominal cavity

 

Diagnosis of Lymphedema

 

The diagnosis of lymphedema depends on thorough inspection and palpation of the patient. The diagnosis can be made easily by observing the signs and symptoms in patients who are at risk of developing lymphedema, e.g. in those who have had cancer surgery involving lymph nodes.

In other cases where the cause is not obvious, certain visual aids can be taken, such as:

  • Magnetic Resonance Imaging (MRI) – gives a better view of the tissues in the arm or leg. It helps to see the characteristics of lymphedema.

  • Computerized Tomography (CT) – it may help to see the areas of the lymphatic system that are blocked.

  • Doppler ultrasound – a special type of ultrasound that looks at the blood flow and pressure. This is helpful in finding obstructions.

  • Lymphoscintigraphy (radionuclide imaging of lymphatic system) – in this test the patient is injected with a radioactive dye and then scanned by a special machine. The dye is seen moving through the lymphatic system and the blockade is easily determined.

Treatment of Lymphedema 

Treatment of lymphedema depends on the severity of the condition. Some of the methods used are:

  • Compression

  • Complete decongestive or manual lymph drainage therapy

  • Surgery

  • Low level laser therapy