Lymphedema

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 20 Aug 2025

Last updated: 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.

Definition

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]

History and exam

Key diagnostic factors

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

Full details

Other diagnostic factors

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

Full details

Risk factors

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

Full details

Diagnostic investigations

1st investigations to order

lymphoscintigram

Full details

Investigations to consider

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

Full details

Treatment algorithm

ONGOING

all patients

Contributors

Authors

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

Disclosures

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

Disclosures

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.

Acknowledgements

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.

Disclosures

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

Peer reviewers

Hakan Brorson, MD, PhD

Senior Consultant Plastic Surgeon

Department of Plastic and Reconstructive Surgery

Lund University

Malmoe University Hospital

Malmoe

Sweden

Disclosures

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

Disclosures

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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

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.Full text Abstract

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.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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Lymphedema

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

all patients

Contributors

Authors

Arin K. Greene, MD, MMSc

Disclosures

Aladdin Hassanein, MD, MMSc, FACS

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Hakan Brorson, MD, PhD

Disclosures

Neil R. Feins, MD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice