Lymphedema

Visão geral 
Teoria 
Diagnóstico 
Tratamento 
ACOMPANHAMENTO 
Recursos 

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Última revisão: 6 Aug 2025

Última atualização: 25 Mar 2025

Lymphedema is a chronic, progressive swelling of tissue with protein-rich fluid as a consequence of developmental (primary lymphedema) or acquired (secondary lymphedema) disruption of the lymphatic system. Extremities are most commonly affected, followed by genitalia.

Most commonly secondary to nematode infection (filariasis), malignancy, or cancer-related treatment.

Typically presents with painless unilateral limb swelling; pitting edema is present in early disease, whereas nonpitting edema is a sensitive but nonspecific finding in advanced disease.

Diagnosis is usually made on clinical grounds, but may be confirmed by lymphoscintigraphy or via other emerging modalities.

There is no cure, but effective treatments are available which can improve outcomes, particularly if given early in the course of the illness. First-line treatment is conservative in nature and involves skin care and compression, ranging from static garments to complex massage and pneumatic compression devices. Surgical procedures are reserved for patients refractory to conservative measures and/or with significant morbidity.

Successful care is multidisciplinary in nature and requires a long-term, collaborative approach between patient and clinicians.

Aims of treatment are to restore function and cosmesis, improve quality of life, minimize physical and psychologic morbidity, and to prevent the development of infection.

Definição

The progressive swelling of a body part, usually an extremity, following developmental (primary lymphedema) or acquired (secondary lymphedema) disruption of the lymphatic system resulting in lymph (a protein-rich fluid) accumulating in the interstitial space. The extremities are most commonly involved, followed by the genitalia.[1]

História e exame físico

Principais fatores diagnósticos

history of malignancy
history of travel to endemic filariasis area
history of previous surgery
history of radiation therapy
painless unilateral swelling of extremity or genitalia
involvement of distal extremity
positive Stemmer sign

Detalhes completos

Outros fatores diagnósticos

history of penetrating trauma to the axilla or groin
limb heaviness and/or weakness
nonpitting edema
skin changes
family history of lymphedema

Detalhes completos

Fatores de risco

cancer treatment
nematode infection (filariasis)
surgery near axillary or inguinal lymph nodes
advanced tumor, nodes, and metastasis (TNM) stage
radiation therapy
trauma
curvilinear scars
family history of lymphedema
genetic syndrome
obesity
chronic venous insufficiency

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

lymphoscintigram

Detalhes completos

Investigações a serem consideradas

MRI scan of affected extremity
CT scan of affected extremity
near infrared fluorescence imaging
lymphangiography
blood smear for filariasis
genetic testing

Detalhes completos

Algoritmo de tratamento

CONTÍNUA

all patients

Colaboradores

Autores

Arin K. Greene, MD, MMSc

Department of Plastic and Oral Surgery

Boston Children's Hospital

Director Lymphedema Program

Vascular Anomalies and Pediatric Plastic Surgery Endowed Chair

Professor of Surgery

Harvard Medical School

Boston

Declarações

AKG declares that he has no competing interests. AKG is an author of a number of references cited in this topic.

Aladdin Hassanein, MD, MMSc, FACS

Associate Professor

Division of Plastic Surgery

Indiana University School of Medicine

Indianapolis

Declarações

AH declares that he has no competing interests. AH is a principal investigator in active grants on lymphedema from the United States National Institute of Health (R21, K08), Plastic Surgery Foundation, Indiana University Health.

Agradecimentos

Dr Arin K. Greene and Dr Aladdin Hassanein would like to gratefully acknowledge Dr Reid A. Maclellan, Dr Sumner A. Slavin, and Dr Carolyn C. Schook, previous contributors to this topic.

Declarações

RAM, SAS, and CCS are authors of a number of references cited in this topic.

Revisores

Hakan Brorson, MD, PhD

Senior Consultant Plastic Surgeon

Department of Plastic and Reconstructive Surgery

Lund University

Malmoe University Hospital

Malmoe

Sweden

Declarações

HB is an author of a number of references cited in this topic.

Neil R. Feins, MD

Professor

Harvard Medical School

Senior Surgeon

Children's Hospital Boston

Boston

Declarações

NRF declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Brix B, Sery O, Onorato A, et al. Biology of lymphedema. Biology (Basel). 2021 Mar 25;10(4):261.Texto completo Resumo

Manrique OJ, Bustos SS, Ciudad P, et al. Overview of lymphedema for physicians and other clinicians: a review of fundamental concepts. Mayo Clin Proc. 2020 Aug 20:S0025-6196(20)30033-1.Texto completo Resumo

Executive Committee of the International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2020 consensus document of the International Society of Lymphology. Lymphology. 2020;53(1):3-19.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Chronic venous insufficiency
- Deep vein thrombosis (DVT)
- Lipedema
Mais Diagnósticos diferenciais
Diretrizes
- The diagnosis and treatment of peripheral lymphedema
- Best practice for the management of lymphoedema: an international consensus
Mais Diretrizes
Folhetos informativos para os pacientes
Breast cancer: locally advanced
Lymphedema: what is it?
Mais Folhetos informativos para os pacientes
Videos
Compression garments explained
Mais vídeos
Conectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal

Lymphedema

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

all patients

Colaboradores

Autores

Arin K. Greene, MD, MMSc

Declarações

Aladdin Hassanein, MD, MMSc, FACS

Declarações

Agradecimentos

Declarações

Revisores

Hakan Brorson, MD, PhD

Declarações

Neil R. Feins, MD

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Videos

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice