Lymphedema- Stages, Signs, and Diagnosis
Secondary lymphedema may be the result of:
- Filariasis (#1 cause for lymphedema worldwide)
- Surgery and /or Radiation Therapy for cancer (#1 cause of lymphedema in the US e.g. breast cancer, malignant melanoma, prostate and bladder cancer, lymphoma, hysterectomy for cancer, radical groin dissection, coronary by-pass surgery)
- Trauma e.g. scarring
- Infection
- Cancer (Malignant lymphedema-when a tumor is responsible for the lymphedema)
- Obesity
- Chronic Venous Insufficiency (CVI)
- Self induce (Artificial Lymphedema, Fictitious Lymphedema)
Anatomical Locations for Lymphedema are:
- Extremities
- Head and Neck
- Genital
- Intestinal
Stages of Lymphedema
Latency Stage:
- Transport capacity reduced
- No visible/palpable edema
- Subjective complaints possible
Stage I (Reversible Lymphedema)
- Accumulation of protein-rich edema fluid
- Pitting edema
- Reduces with elevation (no fibrosis)
Stage II (Spontaneously Irreversible Lymphedema)
- Accumulation of protein-rich edema fluid
- Pitting becomes progressively more difficult
- Connective tissue proliferation (fibrosis)
Stage III (Lymphostatic Elephantiasis)
- Accumulation of protein-rich edema fluid
- Non pitting Fibrosis and sclerosis (severe induration)
- Skin changes (papillomas, hyperkeratosis, etc. )
Signs and Symptoms of Lymphedema include:
- Slow onset, progressive
- Pitting (early stages)
- Starts distally
- Cellulites is common
- Rarely painful
- Discomfort is common (heaviness, achy)
- Skin changes (Hyperkeratosis, Papillomas)
- In contrast with venous disease the skin maintains hydration and elasticity for longer in the disease process
Diagnosis of Lymphedema usually includes:
- History
- Physical examination
- Inspection and palpation
- Subjective complaints
- Tests- R/O other causes of edema
- Lymphoscintigraphy test
