LYMPHEDEMA 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). Physical Exam 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. Laboratory 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). Symptoms
Aching, weakness, redness, heaviness, or tightness in one of your limbs Less flexibility in your wrist or ankle Tight-fitting rings or shoes
Test and Diagnosis
Magnetic resonance imaging (MRI). Using a magnetic field and radio waves, an MRI produces 3-D, high-resolution images. An MRI gives your doctor a better look at the tissues in your arm or leg. He or she might be able to use an MRI to see characteristics of lymphedema.
Computerized tomography (CT). A CT scan also called computerized tomography, or just CT is an X-ray technique that produces detailed, cross-sectional images of your body's structures. CT scans can reveal areas of the lymphatic system that may be blocked.
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 be helpful in finding 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 areas where the lymph fluid is blocked.
Treatment and drug
Exercises. Light exercises that require you to move your affected arm or leg may encourage movement of the lymph fluid out of your limb. These exercises shouldn't be strenuous or make you tired. Instead, they should focus on gentle contraction of the muscles in your arm or leg. Your doctor or a physical therapist can teach you exercises that may help.
Wrapping your arm or leg. Bandages wrapped around your entire limb encourage lymph fluid to flow back out of your affected limb and toward the trunk of your body. When bandaging your arm or leg, start by making the bandage tightest around your fingers and toes. Wrap the bandage more loosely as you move 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. Manual lymph drainage involves special hand strokes on your affected limb to gently move lymph fluid to healthy lymph nodes, where it can drain. 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. If you receive pneumatic compression, you'll wear a sleeve over your affected arm or leg. The sleeve is connected to a pump that intermittently inflates the sleeve, putting pressure on your limb. The inflated sleeve gently moves lymph fluid away from your fingers or toes, reducing the swelling in your arm or leg.
Compression garments. Compression garments include long sleeves or stockings made to compress your arm or leg to encourage the flow of the lymph fluid out of your affected limb. Once you've reduced swelling in your arm or leg through other measures, your doctor may suggest you wear compression garments to prevent your limb from swelling in the future. 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.
