Lymphedema

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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What are the symptoms of lymphedema?

The swelling of lymphedema usually occurs in one or both arms or legs, depending upon the extent and localization of damage. Primary lymphedema can occur on one or both sides of the body as well. Lymphedema may be only mildly apparent or debilitating and severe, as in the case of lymphatic filariasis (see above), in which an extremity may swell to several times its normal size. It may first be noticed by the affected individual as an asymmetry between both arms or legs or difficulty fitting into clothing or jewelry. If the swelling becomes pronounced, fatigue due to added weight may occur, along with embarrassment and restriction of daily activities.

The long-term accumulation of fluid and proteins in the tissues leads to inflammation and eventual scarring of tissues, leading to a firm, taut swelling that does not retain its displacement when indented with a fingertip (nonpitting edema). The skin in the affected area thickens and may take on a lumpy appearance described as an orange-peel (peau d'orange) effect. The overlying skin can also become scaly and cracked, and secondary bacterial or fungal infections of the skin may develop. Affected areas may feel tender and sore, and loss of mobility or flexibility can occur.

Other symptoms can accompany the swelling of lymphedema including:

  • Warmth, redness, or itching
  • Tingling or burning pains
  • Fever and chills
  • Decreased flexibility in the joints
  • Aching, pain, and fullness of the involved area
  • Skin rash

The immune system function is also suppressed in the scarred and swollen areas affected by lymphedema, leading to frequent infections and even a malignant tumor of lymph vessels known as lymphangiosarcoma.

How is lymphedema diagnosed?

A thorough medical history and physical examination are done to rule out other causes of limb swelling, such as edema due to congestive heart failure, kidney failure, blood clots, or other conditions. Often, the medical history of surgery or other conditions involving the lymph nodes will point to the cause and establish the diagnosis of lymphedema.

If the cause of swelling is not clear, other tests may be carried out to help determine the cause of limb swelling.

  • CT or MRI scans may be useful to help define lymph node architecture or to identify tumors or other abnormalities.
  • Lymphoscintigraphy is a test that involves injecting a tracer dye into lymph vessels and then observing the flow of fluid using imaging technologies. It can illustrate blockages in lymph flow.
  • Doppler ultrasound scans are sound wave tests used to evaluate blood flow, and can help identify a blood clot in the veins (deep venous thrombosis) that may be a cause of limb swelling.
Medically Reviewed by a Doctor on 6/8/2015

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