Lymphedema
In medicine, lymphedema exhibits as fluid retention due to damage to, or dysfunction of the lymphatic system. There may be multiple comorbid causes of fluid retention, such as metabolic disturbances.
Diagnosis
Lymphedema should be distinguished from edema, myxedema, and lipedema.[1] Lipedema is more likely to spare the dorsum of the foot.
It is possible, however, to have comorbid edema and lymphedema. For example, a vasodilator used to treat hypertension can cause edema in a patient with cardiac disease. If that patient has had the lymphatics of the lower leg damaged by stripping the saphenous vein for use as an arterial graft, that damage can cause lymphedema to coexist with edema.
Physical examination
On physical examination, fast recovery of pitting is associated with lower serum albumin levels.[2] Fast recovery within 2-3 seconds, is more sensitive than specific at detecting hypoalbuminemia. Presumably this is related to the viscosity of the interstitial fluid thus hypoalbuminemic interstitial fluid can reform more quickly.[2]
Imaging
Oil contrast lymphography may be used for diagnosis. Whole-body lymphangioscintigraphy may help in the diagnosis.[3] Magnetic resonance imaging may help in the diagnosis.[4]
Treatment
Multilayer compression bandaging for 2-3 weeks followed by hosiery may reduce the size of limbs with lymphedema.[5]
References
- ↑ Loughlin V (May 1993). "Massive obesity simulating lymphedema". N. Engl. J. Med. 328 (20): 1496. PMID 8479476. [e]
- ↑ 2.0 2.1 Henry JA, Altmann P (April 1978). "Assessment of hypoproteinaemic oedema: a simple physical sign". British medical journal 1 (6117): 890–1. PMID 638510. PMC 1603695. [e] PubMed Central
- ↑ McNeill GC, Witte MH, Witte CL, et al. (August 1989). "Whole-body lymphangioscintigraphy: preferred method for initial assessment of the peripheral lymphatic system". Radiology 172 (2): 495–502. PMID 2748831. [e]
- ↑ Case TC, Witte CL, Witte MH, Unger EC, Williams WH (1992). "Magnetic resonance imaging in human lymphedema: comparison with lymphangioscintigraphy". Magn Reson Imaging 10 (4): 549–58. PMID 1501525. [e]
- ↑ Badger CM, Peacock JL, Mortimer PS (June 2000). <2832::AID-CNCR24>3.0.CO;2-U "A randomized, controlled, parallel-group clinical trial comparing multilayer bandaging followed by hosiery versus hosiery alone in the treatment of patients with lymphedema of the limb". Cancer 88 (12): 2832–7. PMID 10870068. [e]