Lymfoedeem

Lymfoedeem, also called lymphedema, is a condition characterized by swelling caused by impaired transport or drainage of lymph fluid. It most often affects the arms or legs and is typically chronic and progressive if not treated. The condition can be present at birth (primary lymphedema) or develop later in life (secondary lymphedema), often after surgery, radiation, infection, or injury that damages the lymphatic system.

Primary lymphedema results from congenital abnormalities of lymphatic vessels or nodes. Secondary lymphedema is more common in developed countries and is frequently linked to cancer treatment that involves lymph node removal or radiation, as well as infections such as filariasis in tropical regions. Other contributing factors can include obesity, trauma, or repeated limb infections.

Pathophysiology involves an inability of the lymphatic system to properly drain lymph fluid from the interstitial tissue. The resulting accumulation is usually protein-rich and can lead to tissue swelling, skin changes, and, over time, fibrosis. Symptoms include persistent limb swelling, a feeling of heaviness, tightness, restricted movement, and increased risk of skin infections such as cellulitis.

Diagnosis relies on clinical examination and measurements of limb size and volume, supported by imaging tests such as lymphoscintigraphy, MRI, or lymphangiography to assess lymphatic function. Differential diagnosis includes other forms of edema and vascular or inflammatory conditions.

Management focuses on reducing swelling and preventing complications. This typically includes complex decongestive therapy: manual lymph drainage, compression therapy, exercise, and meticulous skin care to prevent infection. Weight management and treatment of infections are important. Diuretics are not routinely effective for lymphedema. In advanced cases, surgical options such as lymphatic bypass or transfer, or liposuction, may be considered. With proper care, symptoms can be controlled and quality of life improved, though the condition often requires lifelong management.