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Lymphedema

Jon S. Parham, DO, MPH Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Accumulation of lymphatic fluid in the interstitial tissue causing swelling

  • Lymphedema can develop when lymphatic vessels are missing or impaired (primary) or when lymph vessels are d...

DIAGNOSIS

HISTORY

Recent surgery: Vein stripping can significantly exacerbate mild lymphedema: 
  • First symptom: painless swelling

  • Feeling of heaviness in the limb, especially at the end of the day and in ...

TREATMENT

GENERAL MEASURES

  • Seek optimal weight, early treatment of cellulitis, avoid trauma to affected area (direct injury, venipunctures, inept nail care, extreme heat/cold).

  • Achieve mechanical reduct...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Lymphedema will return in several days if patient stops wearing compression garments during the day and bandaging at night. 

Patient Monitoring

  • Daily visit to thera...

REFERENCES

1
Keo HH, Husmann M, Groechenig E, et al. Diagnostic accuracy of fluorescence microlymphography for detecting limb lymphedema. Eur J Vasc Endovasc Surg.  2015;49(4):474–479. [View Abst...

ADDITIONAL READING

  • Choi E, Nahm FS, Lee PB. Sympathetic block as a new treatment for lymphedema. Pain Physician.  2015;18(4):365–372. [View Abstract on OvidMedline]

  • Gardenier JC, Kataru RP, Hespe...

CODES

ICD10

  • I89.0 Lymphedema, not elsewhere classified

  • Q82.0 Hereditary lymphedema

  • I97.89 Oth postproc comp and disorders of the circ sys, NEC

  • I97.2 Postmastectomy lymphedema syndrome

ICD9

  • 457.1 Other lymph...

CLINICAL PEARLS

  • Refer primary lymphedema and lymphedema tarda to genetics.

  • Affected skin with heavy feeling, painless swelling initially, later nonpitting swelling

  • Rule out DVT if unilateral limb or CHF...

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