Lymphoedema

Lymphoedema is a chronic, progressive swelling of tissue with protein-rich fluid as a consequence of developmental (primary lymphoedema) or acquired (secondary lymphoedema) 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 oedema is present in early disease, whereas non-pitting oedema is a sensitive but non-specific 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, minimise physical and psychological morbidity, and to prevent the development of infection.

The progressive swelling of a body part, usually an extremity, following developmental (primary lymphoedema) or acquired (secondary lymphoedema) 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]Lurie F, Malgor RD, Carman T, et al. The American Venous Forum, American Vein and Lymphatic Society and the Society for Vascular Medicine expert opinion consensus on lymphedema diagnosis and treatment. Phlebology. 2022 May;37(4):252-66. https://journals.sagepub.com/doi/10.1177/02683555211053532 http://www.ncbi.nlm.nih.gov/pubmed/35258350?tool=bestpractice.com ​