Diagnosis of Lymphedema – LymphCare

There is no specific test or tool to diagnose lymphedema. This makes the diagnosis difficult and a lot of patients struggle without a correct diagnosis for a long time. There are two main types of lymphedema – primary and secondary lymphedema.

Primary lymphedema is a rare disease that occurs when the lymphatic system has not developed adequately (or is not functioning as it should) from birth due to a genetic reason. Although the symptoms of primary lymphedema often occur in early life, symptoms may also occur after years and it may not be the first diagnosis that healthcare professionals (HCPs) think about. Secondary lymphedema is caused by injuries or diseases and is more common than primary lymphedema.

Who makes the diagnosis of lymphedema?

Your general practitioner (GP) or a nurse is likely to be your first contact person when you notice any signs or symptoms of lymphedema. The first step is to rule out any other reasons for your swelling.

Your Health Care Professional (HCP) will do a general check-up that includes a complete exam of your body, including your skin and soft tissues, lymph nodes, the function of your arteries and veins and any swollen areas. In addition, blood samples provide information about the function of your heart, kidneys, your thyroid glands and blood count.

A complete physical exam and your medical history are important in determining the type of your lymphedema.

After that, your HCP should refer you to a specialist for lymphedema to confirm the diagnosis and to develop a holistic treatment plan with you.

How is lymphedema diagnosed?

Basic diagnostics

Your medical history and the physical exam of your body are the main elements in the diagnosis of lymphedema.

Here are some typical questions that your HCP will ask you:

• When did you first notice any signs or symptoms?
• Do your swellings improve overnight?
• Did you have any infections in the affected area?
• Do you take any medications at the moment and if so, what kind of medication do you take?
• Is there someone in your family with the same signs and symptoms?

Your HCP will examine your affected limb as well. This usually includes the following steps:

1. Check-up of your skin to rule out any injuries or infections
2. Palpation of your tissue (is it hard or soft?) and lymph nodes (are they larger than usual or painful?)
3. Check your body for other swollen areas
4. Measurement of the affected area to monitor the size over time
5. Measurements of your blood vessels (veins and arteries) to check your blood circulation

Advanced diagnostics

Your medical history and the examination of your affected limb are often enough for the diagnosis of lymphedema. Your HCP may need further information, for example when you have other diseases that can cause swelling or in the very early stages of lymphedema. Several diagnostic tools can be useful in such a case:

• Ultrasound scan – uses high-frequency waves that create a picture of your tissue from the outside
• Lymphography – uses a radiocontrast agent that visualizes your lymphatic system under X-ray
• Lymphoscintigraphy – uses a nuclear medicine that visualizes the lymph drainage and your lymph nodes
• MRI (Magnetic Resonance Imaging) scans – uses a magnetic field to create pictures from the inside of your body
• CT (Computed Tomography) scans – uses X-ray to create a detailed picture across your body.

An early diagnosis of lymphedema is important for effective treatment and to prevent progression of your lymphedema. Be aware of your body and stay in contact with your HCP when you notice any changes or new signs and symptoms.

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Lymphoedema – Better Health Channel

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Summary

Read the full fact sheet

• Lymphoedema is characterised by swelling of certain parts of the body, caused by problems with the lymphatic system.
• Women who have undergone surgery and radiotherapy for treatment of breast cancer are particularly susceptible.
• Treatment options include massage, medications, compression bandages, special exercises and surgery.

Lymphoedema is characterised by swelling of certain parts of the body, caused by problems with the lymphatic system. Any part of the body can be affected by lymphoedema, but it tends to target the arms and legs. Around 300,000 Australians will experience lymphoedema at any given time.

Normally, fluid and proteins leak into the body tissues regularly from the blood. This tissue fluid bathes the cells, supplies their nutritional needs and receives back the products of their metabolism. The lymphatic system is a network of tubes throughout the body that drains this fluid (called lymph) from tissues and empties it back into the bloodstream. When this system is not working properly, lymphoedema can occur.

Women who have undergone surgery and radiotherapy for treatment of breast cancer are particularly susceptible to lymphoedema of the arm and, sometimes, the adjacent chest wall on the affected side. Men and women who have had surgery and radiotherapy for the treatment of cancer of the prostate, bowel or reproductive systems are also prone to lymphoedema of the legs or groin areas.

Symptoms of lymphoedema

The symptoms of lymphoedema may include:

• the affected area feels heavy
• the skin feels tight and close to bursting point
• the skin is hotter than other areas of the body
• aching
• pins and needles
• darting pains
• painful joints
• swelling.

The lymphatic system

The main roles of the lymphatic system include managing the fluid levels in the body, filtering out bacteria, and housing types of white blood cells crucial to the body’s ability to fight infection. Muscular movements and contractions of the larger lymph vessels pump the lymph through the network of tubes. One-way valves in the vessels prevent the lymph from travelling backwards. The lymph is cleared ofmicro-organisms in glands of tissue called lymph nodes, located around the body. The lymph is eventually returned to the bloodstream, mainly through blood vessels in the neck.

Swelling, inflammation and risk of infection

Oedema (temporary swelling) occurs when the lymphatic system can’t efficiently remove excess fluid from tissues. A sprained ankle, for example, may be swollen for a few days or weeks. Lymphoedema occurs when the lymphatic system is injured or obstructed. The excess fluid and proteins in the tissue cause swelling and decrease the amount of oxygen available to the cells.
The extra proteins cause inflammation, which leads to fibrosis if lymphoedema is not treated.

The combination of extra proteins and body heat provides a perfect breeding ground for bacteria and fungus. These infections place greater stresses on the already labouring lymphatic system and hospital admission may be required in severe cases.

Primary lymphoedema

Primary lymphoedema is characterised by structural problems with the lymphatic system. The vessels may pump sluggishly or there may be insufficient numbers of vessels, or both may occur. Primary lymphoedema may be present before birth (congenital lymphoedema) or may develop during puberty (lymphoedema praecox) or middle age (lymphoedema tarda).

For those people who have a structural problem with the lymphatic system, the risk of developing a secondary lymphoedema overlying it is higher if they have surgery or radiotherapy for cancer treatment or other surgeries.

Secondary lymphoedema

Secondary lymphoedema is caused by obstructions in the lymphatic drainage system. This may be due to:

• surgery – particularly cancer-related surgery where lymph nodes are removed
• radiotherapy – the x-rays used to kill cancer cells may damage or destroy the nearby lymph nodes
• trauma – an injury to a lymphatic vessel may not heal properly
• parasites – such as worms, which may inhabit and block a lymphatic vessel
• lack of movement – muscular contractions are required to help pump the lymph through the vessels. Lack of movement allows the lymph to pool, particularly in the legs
• allergy – allergic reactions may affect the lymphatic system.

Lymphoedema after treatment for breast cancer

Swelling of the arm, the remaining breast tissue or the chest can follow breast cancer surgery if the nearby lymph nodes in the armpit are removed. Radiotherapy can also cause swelling. Although the incidence varies – depending on the number of lymph nodes removed, whether radiotherapy was given and a range of other factors – around 10 per cent of women will experience lymphoedema to some degree with radiotherapy alone, while up to one-third of women who undergo both radiotherapy and surgery (and have other risk factors) will be affected. Lymphoedema can occur at any stage after the intervention, even 20 years later.

Diagnosis of lymphoedema

Lymphoedema is diagnosed with a number of different tests, including:

• Physical examination – taking into account the person’s prior medical history.
• Scans – specialised x-rays, including CT scans and especially lymphoscintigraphy (which gives a functional picture of the lymphatic system).
• Bioimpedance – to detect fluids.
• Perometry – to detect limb volume and circumference changes.
• Tonometry – to detect changes in the toughness (fibre) of the limb.

Treatment for lymphoedema

Lymphoedema can be treated in a number of ways, including:

• complex physical therapy (CPT) – combining compression, lymphatic draining, special exercises and skin care techniques
• compression bandages – to promote lymph flow
• lymphatic drainage massage – to manually move the lymph to a previously cleared, unaffected area and increase what drainage is present in the limb
• special exercises – muscular movement helps to pump lymph
• medications – such as benzopyrones (Paroven) to help remove excess proteins and associated fluid from the tissues
• massage – the person or their carer can be taught massage techniques
• low-level laser therapy – which can soften fibrotic tissue and help stimulate poorly functioning lymph vessels
• electrical stimulation – of the muscular elements of the lymph vessels and surrounding musculature
• various forms of vibratory massage – all of which in some way vary the tissue pressure and encourage uptake of fluids and their contents into the lymph vessels.

Financial assistance to purchase compression garments is available for people who are pension card holders through the Lymphoedema Compression Garment Program (Tel. 03 8458 4988).

Surgery for lymphoedema

Surgical procedures are not suitable for everyone and are best considered when all other efforts fail. The different types of surgery that may be used include:

• Lymphatic transplant operations – lymphatic vessels from a normal limb are surgically transferred into the affected area.
• Lympho-venous anastomosis – an existing, but blocked lymphatic vessel is joined to a vein.
• Liposuction – excess superficial tissue is sucked out between the skin and muscle layers. (This is most beneficial in the middle, fatty stage of lymphoedema.)

Self-help for lymphoedema

Areas of the body affected by lymphoedema are prone to infection. Suggestions to manage lymphoedema include:

• Pay particular attention to skin care to reduce the risk of infection.
• Avoid cuts, abrasions or other tissue injuries in the affected area.
• Don’t allow your skin to be sunburned.
• Avoid direct heat, such as hot baths, saunas and sunbathing.
• Have your bra professionally fitted.
• Don’t wear tight jewellery.
• Try not to sit down for long periods of time or, if you do, elevate the affected limb.
• Take regular and gentle exercise. (Tai chi and chi gong have recently been shown to be very effective for arm lymphoedemas). Even higher levels of exercise can be beneficial but talk to your health professional before starting any new activity.
• Make sure that any medical procedures such as injections, blood tests or blood pressure readings are taken from the unaffected arm if possible. If this is not possible, make sure that any wound site is well cleaned and signs for any early infection are reacted to.
• Avoid carrying heavy loads for any length of time, as this does not allow good lymph fluid clearance from the tissues.

Where to get help

• Your doctor
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• Australasian Lymphology Association Tel. (03) 9895 4486
• Lymphoedema Compression Garment Program Tel. 03 8458 4988

• What is lymphoedema?External Link, Australasian Lymphology Association
• Lymphoedema managementExternal Link, Australasian Lymphology Association
• Lymphoedema: An information guide for patientsExternal Link, Westmead Breast Cancer Institute, NSW

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Content disclaimer

Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Reviewed on: 31-08-2015

Lymphedema – diagnosis and treatment

Lymphedema of the extremities is a visible and palpable swelling of the legs resulting from stagnation of lymphatic fluid. Lymph is a pale yellow or colorless fluid that contains blood plasma and lymphocytes (white blood cells).

There are many causes of the disease. Often, this is a blockade of the lymph nodes. The pressure in the vessels rises, and the lymph protrudes from the lymphatic channels, filling the tissues. The second reason is heredity. The patient may have too few lymphatic vessels or they may be different from the norm, so they cannot perform their function properly. At the same time, the risk of inheriting the disease is 50%.

The disease is rare. Women suffer from it 9 times more often than men. Usually, lymphedema manifests itself in the return of 15 to 20 years. And even less often the disease occurs in patients older than 35 years.

Diagnosis of Lymphedema of the Lower Extremities

Diagnosis for the presence of lymphedema of the legs begins with a physical examination of the patient. An anamnesis is collected, that is, the patient’s memories of his lifestyle, when he first noticed changes in the lower extremities, past diseases, operations, injuries, allergic reactions, chronic diseases and heredity. All this information helps the doctor determine the possible source of provoking the disease.

Lymphedema has primary and secondary forms. In primary, the patient’s toes will be square in shape. This bright distinguishing feature immediately excludes venous edema.

Imaging is not required to make a diagnosis. It is needed when determining the degree of tissue involvement in the pathological development of the disease. That is, to determine how much tissue has been damaged.

The main tests prescribed for lymphedema:

1. X-ray Needed to rule out bone anomalies.
2. Computed tomography. Usually prescribed for suspected malignancy.
3. Magnetic resonance imaging.
4. Indocyanine green lymphography.
5. Ultrasonography. Evaluation of the condition of the lymphatic and venous vessels for damage.
6. Lymphoscintigraphy. The condition of the lymphatic system is assessed.

Secondary lymphedema is characterized by an association with a previous disease, injury or operation. It is important to establish the cause and determine the extent of the disease in order to prescribe the correct treatment.

After getting acquainted with the clinical symptoms, the stage of the course of the disease is determined:

Stage 1 – edema is not visible from the outside, but the natural ability of the lymphatic system to circulate the lymph is already reduced;
stage 2 – swelling of the legs occurs in the evening;
stage 3 – onset of inflammation and irreversible symptoms;
Stage 4 Abnormal swelling of body parts.

At stages 1 and 2, the disease can be cured. Lymphedema is completely eliminated. In stages 3 and 4, the disease is irreversible.

Treatment of lymphedema

Lifestyle recommendations should be followed if diseased. For example, if you have stage 3 or 4 lymphedema, then you need to undergo therapy to reduce external pressure on the body. Do not wear tight, tight or tight clothing. You need to protect yourself as much as possible from possible injuries. At the first signs of inflammation, such as fever, chills, redness, you should immediately consult a doctor.

Treatment of primary lymphedema

Complex therapy is prescribed for hereditary lymphedema: lymphatic drainage, drugs (diuretics, benzopyrones), compresses, gymnastics, foot skin care to prevent ulcers or injuries, surgery.

Treatment of secondary lymphedema

If the patient has a secondary form of the disease, then the cause of the lymphedema should be treated. For example, when a malignant tumor is detected, treatment is aimed at eliminating the cause and alleviating the symptoms.

Timely treatment will help to avoid harmful consequences

It is necessary to predict the complications of the disease based on its causes and stage. Usually, with a hereditary predisposition to lymphedema, you can reduce the chances of its occurrence in simple ways. For example, avoid being overweight. Then the risk of inheriting the disease is reduced from 50% to 25%, which, you see, is a very significant result.

A timely visit to a doctor and timely treatment also reduces the chances of an unfavorable prognosis by almost 5 times. This is a powerful reason to protect yourself.

Phlebologists of the CDC Arbatsky help patients cope with the disease in the initial stages of the disease, almost until complete recovery. There is all the necessary modern equipment for diagnosing and effective therapy.

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treatment of elephantiasis in Kaliningrad — Nadezhda Medical Center

Lymphedema of the legs is a common disease. It is characterized by swelling of the soft tissues caused by a violation of the outflow of fluid through the lymphatic vessels. About 5% of patients with peripheral vascular disease suffer from lymphedema.

In accordance with the ICD, lymphedema is divided into two basic types:

1. Primary edema. Pathology first manifests itself in childhood or adolescence. Congenital lymphedema occurs in girls in 80% of cases.
2. Secondary edema. This type of disease is much more common. Prerequisites for its development are injuries, operations and infections.

Along with the above, one more form is distinguished separately – chronic. It is characterized by severe treatment. The cause of the development of the pathological process can be even a minor injury to the skin.

Symptoms of lymphedema

Lymphedema of the lower extremities rarely appears immediately. Its symptoms may occur 13-15 years after surgery or injury. The characteristic signs of the disease are:

– Feeling of heaviness in the limbs.
– Pain.
– Restriction of leg mobility.
– Feeling of weakness at the site of injury.
– The manifestation of edema, with pressure on which no dimples remain.

Causes

Primary lymphedema occurs when there is a congenital pathology of the lymphatic system. There are also diseases that are caused by hereditary factors.

Acquired edema of the lower extremities develops against the background of infection (eg, erysipelas), tumors of the lymphatic system, ionizing radiation, varicose veins. Often the causes of the disease are burns, injuries and surgical interventions.

Diagnostics

Lymphedema is diagnosed and treated by a phlebologist. In order to assess damage to the lymphatic vessels, lymphangiography is used. If the vessels of the lower extremities with lymphedema are in the form of a spindle or beads, this indicates the preservation of motor skills.

In order to study the dynamics of the pathological process, lymphoscintigraphy is used. MRI, duplex scanning and computed tomography are also used to diagnose the disease.