Lymphedema

Lymphedema is a topic covered in the 5-Minute Clinical Consult.

To view the entire topic, please or .

Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:

-- The first section of this topic is shown below --

Basics

Description

  • Accumulation of lymphatic fluid in the interstitial tissue causing swelling
  • Lymphedema can develop when lymphatic vessels are missing or impaired (primary) or when lymph vessels are damaged or lymph nodes are removed (secondary).
  • Most common in the lower limb(s) (80%) but also can occur in the arm(s), face, trunk, and external genitalia

Epidemiology

Incidence
  • Predominant sex: female > male
  • Predominant age: any age
  • 13% of patients with breast cancer treated with surgery; 42% of those treated with surgery and radiation therapy; 25% after GYN cancer surgery
  • Milroy disease presents at birth; estimated to be between 1/6,000 and 1/300 live births
  • Meige disease develops during puberty.

Prevalence
  • 120 million people worldwide are affected with lymphatic filariasis in 73 countries but no primary infections in United States.
  • 10 million people are affected by nonfilarial secondary lymphedema in the United States.

Etiology and Pathophysiology

Secondary lymphedema:

  • Postoperative: gradual failure of distal lymphatics, which have to “pump” lymph at a greater pressure through damaged proximal ducts
  • Risk is higher with postoperative radiation because radiation reduces regrowth of ducts due to fibrous scarring.
  • Trauma; recurrent infection; malignancy, including metastatic disease; and marked obesity
  • Lymphangiogenesis inhibition and tissue fibrosis promotion by T cells appear to promote lymphedema.
  • Developing countries: Most common cause is filariasis (Wuchereria bancrofti).
Genetics
  • Milroy disease: autosomal dominant; diagnosed either at birth or the 1st year of life
  • Lymphedema praecox has onset between the ages of 1 and 35 years.
  • Lymphedema tarda occurs in those >35 years of age.
  • Genetics referral: primary and lymphedema tarda

Risk Factors

  • Filariasis: most common cause worldwide
  • Mastectomy, melanoma surgery
  • Prior trauma, serious burns, infection of affected limb
  • Lymphadenectomy or radiation therapy for malignancy
  • Obesity (>50 body mass index)
  • Inflammatory disorders: arthritis, sarcoidosis, dermatitis

General Prevention

Healthy body weight maintenance; treatment of congestive heart failure (CHF), early recognition of infection and cancer, and venous insufficiency

Commonly Associated Conditions

Venous disease, morbid obesity, regional cancer, filarial disease (Africa and Asia)

-- To view the remaining sections of this topic, please or --

Basics

Description

  • Accumulation of lymphatic fluid in the interstitial tissue causing swelling
  • Lymphedema can develop when lymphatic vessels are missing or impaired (primary) or when lymph vessels are damaged or lymph nodes are removed (secondary).
  • Most common in the lower limb(s) (80%) but also can occur in the arm(s), face, trunk, and external genitalia

Epidemiology

Incidence
  • Predominant sex: female > male
  • Predominant age: any age
  • 13% of patients with breast cancer treated with surgery; 42% of those treated with surgery and radiation therapy; 25% after GYN cancer surgery
  • Milroy disease presents at birth; estimated to be between 1/6,000 and 1/300 live births
  • Meige disease develops during puberty.

Prevalence
  • 120 million people worldwide are affected with lymphatic filariasis in 73 countries but no primary infections in United States.
  • 10 million people are affected by nonfilarial secondary lymphedema in the United States.

Etiology and Pathophysiology

Secondary lymphedema:

  • Postoperative: gradual failure of distal lymphatics, which have to “pump” lymph at a greater pressure through damaged proximal ducts
  • Risk is higher with postoperative radiation because radiation reduces regrowth of ducts due to fibrous scarring.
  • Trauma; recurrent infection; malignancy, including metastatic disease; and marked obesity
  • Lymphangiogenesis inhibition and tissue fibrosis promotion by T cells appear to promote lymphedema.
  • Developing countries: Most common cause is filariasis (Wuchereria bancrofti).
Genetics
  • Milroy disease: autosomal dominant; diagnosed either at birth or the 1st year of life
  • Lymphedema praecox has onset between the ages of 1 and 35 years.
  • Lymphedema tarda occurs in those >35 years of age.
  • Genetics referral: primary and lymphedema tarda

Risk Factors

  • Filariasis: most common cause worldwide
  • Mastectomy, melanoma surgery
  • Prior trauma, serious burns, infection of affected limb
  • Lymphadenectomy or radiation therapy for malignancy
  • Obesity (>50 body mass index)
  • Inflammatory disorders: arthritis, sarcoidosis, dermatitis

General Prevention

Healthy body weight maintenance; treatment of congestive heart failure (CHF), early recognition of infection and cancer, and venous insufficiency

Commonly Associated Conditions

Venous disease, morbid obesity, regional cancer, filarial disease (Africa and Asia)

There's more to see -- the rest of this entry is available only to subscribers.