Lymphedema

General Considerations

• Abnormal collection of protein-laden fluid in the soft tissues from lymphatic obstruction
• This, in turn, leads to extravascular accumulation of water and soft tissue swelling
• Affects primarily lower extremities (80%)
• Primary form involves a congenital defect in lymphatic system and may be associated with Turner, Klinefelter, and Noonan Syndromes, trisomy 21, 13 or 18
• Secondary form may be due to neoplasm, filariasis, obesity, trauma or surgery/radiation therapy

Clinical Findings

• Chronic swelling of an extremity (not the same patient as radiograph)
• Fever, chills, weakness
• Redness and thickening of skin
• Impairment of activities due to size and weight of extremity
• Non-tender pitting edema progressing to non-pitting edema
• Elephantiasis nostra verrucosa primarily on the shins

Imaging Findings

• Diagnosis is made clinically
• Imaging is generally not needed
• MRI may show causes of obstruction

Differential Diagnosis

• Congestive heart failure
• Chronic venous stasis
• Deep vein thrombosis
• Filariasis

Complications

• Cellulitis
• Lymphangitis

Treatment

• Pharmacotherapy includes benzopyrones, retinoid-like agents, topical skin products and anthelminthic agents
• Compression stockings and physical therapy
• Elevation of limb

Lymphedema. There is marked soft tissue swelling of the left lower extremity. The patient had a negative workup for filarial disease and the leg was normal.
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