Lymphedema

Lymphedema refers to tissue swelling caused by an accumulation of protein-rich fluid that's usually drained through the body's lymphatic system. It most commonly affects the arms or legs, but can also occur in the chest wall, abdomen, neck and genitals.

Causes of Lymphedema #

Cancer #

If cancer cells block lymph 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.

Radiation treatment for cancer #

Radiation can cause scarring and inflammation of lymph nodes or lymph vessels.

Surgery #

In cancer surgery, lymph nodes are often removed to see if the disease has spread. However, this doesn’t always result in lymphedema.

Parasites #

In developing countries in the tropics, the most common cause of lymphedema is infection with threadlike worms that clog the lymph nodes.

Symptoms of Lymphedema #

• Swelling of part or all of the arm or leg, including fingers or toes

• A feeling of heaviness or tightness

• Restricted range of motion

• Recurring infections

• Hardening and thickening of the skin (fibrosis)

Complications of Lymphedema #

Skin infections (cellulitis) #

The trapped fluid provides fertile ground for germs, and the smallest injury to the arm or leg can be an entry point for infection. Affected skin appears swollen and red and is typically painful and warm to the touch. Your doctor may prescribe antibiotics to keep on hand so that you can start taking them immediately.

Sepsis #

Untreated cellulitis can spread into the bloodstream and trigger sepsis — a potentially life-threatening condition that occurs when the body’s response to an infection damages its own tissues. Sepsis requires emergency medical treatment.

Leakage through the skin #

With severe swelling, the lymph fluid can drain through small breaks in the skin or cause blistering.

Skin changes #

In some people with very severe lymphedema, the skin of the affected limb can thicken and harden so it resembles the skin of an elephant.

Cancer #

A rare form of soft tissue cancer can result from the most-severe cases of untreated lymphedema.

Diagnosis of Lymphedema #

MRI scan #

Using a magnetic field and radio waves, an MRI produces 3D, high-resolution images of the involved tissue.

CT scan #

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

Ultrasound #

This test uses sound waves to produce images of internal structures. It can help find obstructions within the lymphatic system and vascular system.

Lymphoscintigraphy #

During this test, the person is injected with a radioactive dye and then scanned by a machine. The resulting images show the dye moving through the lymph vessels, highlighting blockages.

Treatment of Lymphedema #

Medications #

Lymphedema greatly increases the risk of skin infections (cellulitis). Your doctor may prescribe antibiotics for you to keep on hand so that you can start taking them immediately once symptoms appear.

Therapy #

Specialized lymphedema therapists can teach you about techniques and equipment that can help reduce lymphedema swelling. Examples include:

Exercises #

Gentle contraction of the muscles in the arm or leg can help move the excess fluid out of the swollen limb.

Manual lymph drainage #

Therapists trained in this massage-like technique use very light pressure to move the trapped fluid in the swollen limb toward an area with working lymph vessels. People should avoid manual lymph drainage if they have a skin infection, blood clots or active cancer in the affected limb.

Compression bandages #

Using low-stretch bandages to wrap the entire limb encourages lymph fluid to flow back toward the trunk of the body.

Compression garments #

Close-fitting elastic sleeves or stockings can compress the arm or leg to encourage lymph fluid drainage. These garments often require a prescription to ensure that the proper amount of compression is used. You may need to be measured by a professional to ensure proper fit.

Sequential pneumatic compression #

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

Surgical and other procedures #

Surgical treatment for lymphedema may include:

Lymph node transplant #

Lymph nodes are taken from a different area of the body and then attached to the network of lymph vessels in the affected limb. Many people with early-stage lymphedema see good results from this surgery and can decrease the amount of compression needed.

New drainage paths #

Another option for early-stage lymphedema, this procedure creates new connections between the lymph network and blood vessels. The excess lymph fluid is then removed from the limb via blood vessels.

Removal of fibrous tissue #

In severe lymphedema, the soft tissues in the limb become fibrous and hardened. Removing some of this hardened tissue, often through liposuction, can improve the limb’s function

In very severe cases, hardened tissue and skin may be removed with a scalpel.