Lymphatic Edema

Definition


What Is Lymphedema?


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Lymphatic fluid is normally transported out of a region of the body by an extensive network of lymph vessels. When the collection of protein-rich fluid persists in a specific area, it can attract more fluid and thus worsen the swelling. In addition to increased fluid in the area, the body experiences an inflammatory reaction resulting in scar tissue called fibrosis in the affected area. The presence of fibrosis makes it even more difficult for the excess fluid to be eliminated from the area. As a result, the increased fluid and fibrosis prevents the delivery of oxygen and essential nutrients to the area, which in turn can delay wound healing, provide a culture medium for bacteria to grow, and increase the risk of infections in or below the skin called cellulitis orlymphangitis.

Lymphatic system


What Is The Lymphatic System?


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Networks of the lymphatic system are situated in several areas of the body with a specific drainage pathway for each individual area.


Superficial Lymph Nodes Include:

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Inguinal: Located at the bend of the hip, these nodes receive fluid from the leg, lower abdomen, gluteal region, and external genitals.


Deep Lymph Nodes Include:

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Lymphatic tissue is found in other areas of the body including the tonsils, spleen, intestinal wall, and bone marrow.


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Causes


Causes of primary lymphedema


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  • Milroy's disease (congenital lymphedema). This disorder begins in infancy and causes lymph nodes to form abnormally.

  • Meige's disease (lymphedema praecox). This disorder often causes lymphedema around puberty or during pregnancy, though it can occur later, until age 35.

  • Late-onset lymphedema (lymphedema tarda). This occurs rarely and usually begins after age 35.

Causes of secondary lymphedema


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  • Surgery. Removal of or injury to lymph nodes and lymph vessels may result in lymphedema. For example, lymph nodes may be removed to check for spread of breast cancer, and lymph nodes may be injured in surgery that involves blood vessels in your limbs.

  • Radiation treatment for cancer. Radiation can cause scarring and inflammation of your lymph nodes or lymph vessels.

  • Cancer. If cancer cells block lymphatic vessels, lymphedema may result. For instance, a tumor growing near a lymph node or lymph vessel could enlarge enough to block the flow of the lymph fluid.

  • Infection. An infection of the lymph nodes or parasites can restrict the flow of lymph fluid. Infection-related lymphedema is most common in tropical and subtropical regions and is more likely to occur in developing countries.

Signs & Symptoms


Lymphedema signs and symptoms, which occur in your affected arm or leg, include:


  • Swelling of part or all of your arm or leg, including fingers or toes
  • A feeling of heaviness or tightness
  • Restricted range of motion
  • Aching or discomfort
  • Recurring infections
  • Hardening and thickening of the skin (fibrosis)

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Tests and Diagnosis


  • MRI scan. Using a magnetic field and radio waves, an MRI produces 3-D, high-resolution images.

  • CT scan. This X-ray technique produces detailed, cross-sectional images of your body's structures. CT scans can reveal blockages in the lymphatic system.

  • Doppler ultrasound. This variation of the conventional ultrasound looks at blood flow and pressure by bouncing high-frequency sound waves (ultrasound) off red blood cells. Ultrasound can help find obstructions.

  • Radionuclide imaging of your lymphatic system (lymphoscintigraphy). During this test you're injected with a radioactive dye and then scanned by a machine. The resulting images show the dye moving through your lymph vessels, highlighting blockages.


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Treatments


There's no cure for lymphedema. Treatment focuses on reducing the swelling and controlling the pain. Lymphedema treatments include:


  • Exercises. Light exercises in which you move your affected limb may encourage lymph fluid drainage and help prepare you for everyday tasks, such as carrying groceries. Exercises shouldn't be strenuous or tire you but should focus on gentle contraction of the muscles in your arm or leg. A certified lymphedema therapist can teach you exercises that may help.

  • Wrapping your arm or leg. Bandaging your entire limb encourages lymph fluid to flow back toward the trunk of your body. The bandage should be tightest around your fingers or toes and loosen as it moves up your arm or leg. A lymphedema therapist can show you how to wrap your limb.

  • Massage. A special massage technique called manual lymph drainage may encourage the flow of lymph fluid out of your arm or leg. Be sure to have it done by someone specially trained in the technique.
    Massage isn't for everyone. Avoid massage if you have a skin infection, active cancer, blood clots or congestive heart failure. Also avoid massage on areas of your body that have received radiation therapy.

  • Pneumatic compression. A sleeve worn over your affected arm or leg connects to a pump that intermittently inflates the sleeve, putting pressure on your limb and moving lymph fluid away from your fingers or toes.

  • Compression garments. Long sleeves or stockings made to compress your arm or leg encourage the flow of the lymph fluid out of your affected limb. Wear a compression garment when exercising the affected limb.
    Obtain a correct fit for your compression garment by getting professional help. Ask your doctor where you can buy compression garments in your community. Some people will require custom-made compression garments.

  • Complete decongestive therapy (CDT). This approach involves combining therapies with lifestyle changes. Generally, CDT isn't recommended for people who have high blood pressure, diabetes, paralysis, heart failure, blood clots or acute infections.

Surgery


  • Debulking Surgery
  • Lymphatic Drainage
  • Groin Exploration
  • Lymphovenous Anastomosis
  • Liposuction

Prevention


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To reduce your risk of lymphedema, try to:


  • Protect your arm or leg. Avoid injury to your affected limb. Cuts, scrapes and burns can invite infection. Protect yourself from sharp objects. For example, shave with an electric razor, wear gloves when you garden or cook, and use a thimble when you sew. If possible, avoid medical procedures, such as blood draws and vaccinations, in your affected limb.

  • Rest your arm or leg while recovering. After cancer treatment, exercise and stretching are encouraged. But avoid strenuous activity until you've recovered from surgery or radiation.

  • Avoid heat on your arm or leg. Don't apply ice or heat, such as with a heating pad, to your affected limb. Also, protect your affected limb from extreme cold.

  • Elevate your arm or leg. Whenever possible, elevate your affected limb above the level of your heart.

  • Avoid tight clothing. Avoid anything that could constrict your arm or leg, such as tightfitting clothing and, in the case of your arm, blood pressure cuffs. Ask that your blood pressure be taken in your other arm.

  • Keep your arm or leg clean. Make skin and nail care high priorities. Inspect the skin on your arm or leg daily, watching for changes or breaks in your skin that could lead to infection. Don't go barefoot.