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Lymphedema

Dana M Vlachos, DO, Rahim Shareef, Doctor of Osteopathic Medicine and Natasha E Scaria, MD Reviewed 04/2024
 


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 ...

DIAGNOSIS

HISTORY

  • First symptom is often painless swelling

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

PHYSICAL EXAM

  • Initial: pitting edema, can spread proximally...

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...

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] ...

CODES

ICD10

  • I89.0 Lymphedema, not elsewhere classified

  • I97.2 Postmastectomy lymphedema syndrome

  • Q82.0 Hereditary lymphedema

SNOMED

  • 205545009 Congenital elephantiasis

  • 234097001 Lymphedema

  • 254199006 Hereditary...

CLINICAL PEARLS

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

  • No medications, including diuretics, are useful.

  • Rule out DVT if unilateral limb affected ...

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