Learning Radiology xray montage


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


  • Cellulitis
  • Lymphangitis


  • 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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Lymphedema. KM Rossy and NS Scheinfeld. eMedicine