Primary and secondary lymphedema
Primary lymphedema is associated with congenital deficiency of the lymphatic vessels. It can appear in infancy, but more often manifests itself in adolescence or young adults, often without obvious cause. Secondary lymphedema occurs much more often and develops when the drainage of lymph is disrupted by an already formed cause: after removal of lymph nodes during oncological surgery, after radiation therapy, trauma, severe or repeated soft tissue infections, and severe obesity. A separate cause in a number of countries is parasitic infection of the lymphatic system.
- Primary - congenital anomaly of the lymphatic vessels
- Secondary - after operations with removal of lymph nodes
- After radiation therapy
- After erysipelas and other infections
- For obesity and prolonged immobility
- Parasitic form in endemic regions
How edema develops and stages of the disease
Due to impaired outflow, fluid with a high protein content accumulates in the tissues. Protein retains water and maintains chronic inflammation, so over time, connective tissue grows in the subcutaneous tissue and fat is deposited. The swelling turns from soft to dense, ceases to subside overnight, the skin thickens, and the folds deepen. An early sign is the inability to gather the skin on the back of the toe into a fold. The earlier therapy is started, the greater the chance of stopping the process at a reversible stage.
- Latent stage: there is no swelling yet, there is a feeling of heaviness
- Mild swelling that improves with rest and elevation of the limb
- Dense swelling that does not go away overnight
- Marked increase in volume, rough skin, limited movement
- Sign of thickening of the skin on the back of the toe
How is lymphedema different from other edemas?
Leg swelling occurs with heart failure, kidney disease, low blood protein, taking certain medications, venous insufficiency and deep vein thrombosis. Edema in diseases of the heart and kidneys is usually bilateral, symmetrical, mild and intensifies in the evening. Venous edema is accompanied by varicose veins, skin pigmentation in the lower third of the leg and pain. Lymphedema is often one-sided, affecting the dorsum of the foot and toes, and the skin over it is thickened. Lipedema is a separate condition with a symmetrical growth of adipose tissue on the legs and preserved shape of the feet.
- Cardiac and renal edema - symmetrical, mild
- Venous edema - with varicose veins and skin pigmentation
- Deep vein thrombosis - acute, painful, requires urgent care
- Lipedema - symmetrical, feet unchanged
- Lymphedema - unilateral, with swelling of the dorsum of the foot and toes
Survey
The diagnosis in most cases is made by examination and medical history: the doctor clarifies whether there have been operations, radiation therapy, erysipelas, measures the circumference of the limbs at symmetrical levels and assesses the condition of the skin. Ultrasound examination of the veins is necessary to exclude thrombosis and venous insufficiency, and ultrasound of soft tissues shows a characteristic accumulation of fluid. General tests, creatinine, blood protein and thyroid hormones help to exclude systemic causes of edema. In difficult cases, lymphoscintigraphy or magnetic resonance imaging is performed.
- Inspection and measurement of limb circumferences
- Ultrasound of veins to exclude thrombosis
- Ultrasound of soft tissues
- Blood and urine tests, assessment of kidney and thyroid function
- Lymphoscintigraphy and MRI in complex cases
- Oncological examination for suspected compression of lymph nodes
Treatment and prevention of exacerbations
The basis of treatment is complex anti-edematous therapy. It includes tailored compression hosiery or a multi-layer bandage, manual lymphatic drainage, special exercises and careful skin care. The compression is worn constantly during the day, otherwise the swelling returns. The skin is cleansed and moisturized daily, cuts, burns, injections and measuring pressure on the sore arm are avoided, so as not to provoke erysipelas. Diuretics for lymphedema are ineffective and are prescribed only for other indications. Surgical methods are used in individual cases and according to the decision of a specialist.
- Compression hosiery and bandaging
- Manual lymphatic drainage and pneumocompression
- Therapeutic exercises and walking
- Daily skin care and protection against injury
- Weight loss
- Timely treatment of erysipelas
- Microsurgical operations according to indications