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Clinical Summary

Lymphedema occurs from obstruction of lymphatic channels and is associated with malignancy, radiation, trauma, surgery, inflammation, infection, parasitic invasion, DVT, paralysis, renal insufficiency, heart failure, cirrhosis, and malnutrition. Lymphedema is characterized by painless pitting edema, fatigue, increase in limb size (particularly during the day while upright), and presence of lymph vesicles. The skin becomes thickened and brown in the late stages.

Management and Disposition

Elevation, pneumatic compression boots and firm elastic stockings, maintenance of healthy skin, and avoidance of cellulitis and lymphangitis are the mainstays of symptomatic treatment. Treatment of the underlying disease may be curative.

Pearls

  1. The dorsum of the toes and feet are always involved in lymphedema, unlike other causes of edema.

  2. Careful examination for heart failure and screening for renal insufficiency should be completed for all patients.

FIGURE 12.20

Lymphedema. Pitting edema is seen in a woman with lymphedema of the lower extremities. Note how the impression of the thumb remains on the foot in this patient with lymphedema. (Photo contributor: Selim Suner, MD, MS.)

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