What is lymphedema?
The lymphatic system is the least known of the circulatory systems in the body (after the arterial and venous systems). It consists of lymph nodes and lymphatic vessels that run through your body. It transports a protein rich fluid from the cells of the body to the lymph nodes which help filter out waste products and then return the fluid to your blood. When the lymphatic vessels or nodes are damaged or do not develop normally, the fluid can build up and cause swelling or an arm or a leg. This is called lymphedema There are two types of lymphedema- congenital and acquired. In congenital lymphedema, you are born without adequate or properly developed lymph channels or nodes. Swelling usually appears in your leg during the teenage years. In acquired lymphedema, swelling occurs during adulthood. Sometimes there is an injury to the lymphatic system (such as surgery that removed nodes or radiation to an area with nodes), but often the exact cause of this is never found. The injury to the lymphatic system can occur many years before the swelling develops. It is much more commong than congenital or primary lymphedema..

What are the symptoms of lymphedema?
Lymphedema usually presents as painless swelling of an extremity. Unlike swelling caused by venous problems, it usually extends into a patients foot or hand causing a “squaring” of the ankle or wrist. It also usually does not completely resolve with overnight elevation. When the swelling is severe it can cause pain. In addition, the patient becomes more susceptible to infections in the affected limb, from even small injuries or bites. These infections are called “lymphangitis”. Once the tissue is traumatized by an infection , it is more susceptible to repeat episodes. Over time, the patient’s skin becomes woody and fibrous.

How is lymphedema diagnosed?
Lympedema can often be diagnoses simply by physical exam. It is often a diagnosis that is made after other causes of limb swelling are excluded. Direct testing of the lymphatic system by lymposcintigraphy where a low-dose radioactive substance in injected to trace the flow of lymph fluid is very uncommonly used today. Most patients will however undergo venous duplex ultrasound to make sure they don’t have a venous blood clot or leaky valves in their veins as a cause of their swelling. In addition, many will get a CT (computed tomography) scan to look for causes of the swelling in their abdomen or pelvis. Occasionally, magnetic resonance imaging can detect patterns in your internal tissues that are characteristic of lymphedema.

How is lymphedema treated?
There is unfortunately no cure for lymphedema. Treatment of this chronic problem requires taking precautions and using methods that help only temporarily. This includes wearing compression hose (usually 30-40mm Hg pressure) and trying manual lymphatic drainage. This uses massage of the affected limb to help drain it of the excess fluid and to stimulate the lymphatic system. It must be done on a regular basis and is usually done by the patient himself. Mechanical roller pumps have also been used to help move the fluid out of the limb. Diuretics have clearly been shown to have no benefit in the treatment of lymphedema. Antibiotics do have a role in patients who develop lymphangitis. Sometimes, this requires hospitalization.

The most important aspect of treating lymphedema is preventing infection and minimizing swelling. Keeping your weight normal, minimizing prolonged standing, preventing exposure of your feet to potential traumas, keeping your limb clean and dry are all helpful in preventing infection.

Surgery is uncommonly helpful in the treatment of most patients with lymphedema. In a few circumstances, surgery can be used to remove excess fibrous tissue and skin.