Lymfaedema

Lymphedema, sometimes spelled lymphaedema or lymfaedema, is a chronic condition characterized by swelling caused by impaired lymphatic drainage. It most commonly affects the arms or legs but can involve other parts of the body. Lymphedema is caused by damage to or congenital abnormalities of the lymphatic system. Primary lymphedema results from developmental defects of the lymphatic vessels and may present at birth or later in life. Secondary lymphedema arises from injury or disease, most notably cancer treatment involving lymph node removal or radiation, infections such as filariasis, trauma, or chronic venous insufficiency; obesity is a risk factor.

Pathophysiology and symptoms: when lymphatic flow is reduced, protein-rich interstitial fluid accumulates, causing swelling and tissue changes. Symptoms include persistent, sometimes painless swelling; a sensation of heaviness or fullness; tight clothing or jewelry; reduced range of motion; and recurrent skin infections such as cellulitis.

Diagnosis: diagnosis relies on medical history and physical examination. The Stemmer sign (inability to pinch the skin at the base of a toe or finger) can support the diagnosis. Imaging such as lymphoscintigraphy, MRI, or CT, and venous Doppler studies help exclude other conditions and assess lymphatic function.

Management and prognosis: the mainstay is complex decongestive therapy, which includes manual lymph drainage, compression garments, exercise, and meticulous skin care to reduce infection risk. Elevation and weight management can help. In selected cases, surgical options such as lymphaticovenous bypass, vascularized lymph node transfer, or debulking liposuction may be considered. With consistent treatment, swelling can be controlled and quality of life improved, though lymphedema is typically a long-term condition requiring ongoing management.