Lymphedema

What is Lymphedema?
Lymphatic fluid accumulates causing swelling in the arms, legs, breast, shoulder, abdomen, neck, or head due to damage to the lymphatic vessels. Lymphedema can be congenital or result from surgery, radiation, infection, accidents, or other trauma that damages the lymphatic system.

Primary Lymphedema
Primary lymphedema is caused by a congenital deformity and may be present at birth. The onset of lymphedema during puberty is known as lymphedema praecox and is most common in females. The onset of lymphedema may not be until adulthood when it is known as lymphedema tarda.

Examples:
Milroy’s Disease
Parkes Weber Syndrome
Klippel Trenaunay
Meige’s Disease

Secondary Lymphedema
Secondary lymphedema is usually the result of lymph node dissection, radiation, or a combination of the two. Surgical treatment for the following conditions may result in damage to the lymphatics: cancer of the breast, prostate, testicular, bladder, colon, neck, head, or melanoma. Secondary lymphedema may occur immediately after surgery or it may not develop until chemotherapy is administered. Infection, or other trauma such as an accident, may also cause damage to the lymphatic vessels.

Other events that may precipitate lymphedema are flying in decreased cabin pressure or an insect sting. Lymphedema that develops for unexplained reasons is known as idiopathic lymphedema.

In 73 nations, filariasis occurs when a mosquito-born parasite infests and damages the lymphatic channels causing lymphedema. Filariasis is not seen in the United States.

Stages of Lymphedema
Stage 1
This is the mildest stage. Swelling can be controlled by elevation. Patients find their limbs are normal in size first thing in the morning. The tissue is smooth and pits when pressed.

Stage 2
This is a moderate stage in which fibroslerotic tissue changes occur. The tissue does not pit when pressed and has a spongy quality. Elevation is not effective and the swelling increases. The limb is prone to infections, which causes more swelling and fibrotic tissue.

Stage 3
This is severe lymphedema known as lymphostatic elephantiasis. The limb is hard and fibrotic. Swelling is irreversible and the limb is very large. Infections are a great concern. Loss of function and discomfort in the limb is common.