2nd July 2023

Lymphoedema

Defined as an ‘abnormal accumulation of interstitial fluid and fibroadipose tissues resulting from injury, infection, or congenital abnormalities of the lymphatic system’. When the lymphatic load exceeds the overall transport capacity of the lymphatic system, this results in the build-up of fluid in the interstitial tissues.

It is classified as either primary or secondary.

Primary causes are those without a precipitating cause and are congenital or inherited. It tends to present in children but can also present later in adulthood. This is referred to as Milroy disease.

Secondary lymphoedema occurs due to other conditions or treatments. The most common cause is cancer and cancer treatment, including radiotherapy and surgical excision of lymph nodes. Other causes include infection, inflammatory disorders, obesity, and chronic causes of lymphatic overload (venous insufficiency, trauma, and burns).

Identification and Diagnosis

The diagnosis can be made from a careful history and examination. Physical examination should include vascular, skin, and soft tissue examination with focus on the lymph nodes. Most cases are unilateral, often from precipitating events such as lymph node excision from cancer or radiotherapy. The circumference of the limbs should also be measured. Additional imaging is usually not required. However, in cases where imaging is required, CT and MR have been used but with variable results.

Management

The first line treatment is decongestive lymphatic therapy. This utilises multiple techniques to help control symptoms. The four main components are compression bandages, skin care, exercises to improve lymph drainage and specialised massage techniques to stimulate the flow of fluid in the lymphatic system.