Chronic, painless edema, usually of the lower extremities; may be primary (inherited) or secondary to lymphatic damage or obstruction (e.g., recurrent lymphangitis, tumor, filariasis).
Marked pitting edema in early stages; limb becomes indurated with nonpitting edema chronically. Differentiate from chronic venous insufficiency, which displays hyperpigmentation, stasis dermatitis, and superficial venous varicosities.
Abdominal and pelvic ultrasound or CT or MRI to identify obstructing lesions. Lymphangiography or lymphoscintigraphy (rarely done) to confirm diagnosis. If unilateral edema, differentiate from DVT by noninvasive venous studies (above).
Treatment: Lymphedema (1) Meticulous foot hygiene to prevent infection, (2) leg elevation, (3) compression stockings and/or pneumatic compression boots. Diuretics should be avoided to prevent intravascular volume depletion. |
For a more detailed discussion, see Creager MA, Loscalzo J: Arterial Diseases of the Extremities, Chap. 302, p. 1643; Creager MA, Loscalzo J: Chronic Venous Disease and Lymphedema, Chap. 303, p. 1650, in HPIM-19. |
Outline