Lymphedema





Lymphedema refers to swelling that occurs most often in your arms or legs. It may affect just one arm or leg, but sometimes lymphedema can involve both arms or both legs.

This type of swelling occurs when a blockage in your lymphatic system prevents the lymph fluid in your arm or leg from draining adequately. As the fluid accumulates, the swelling continues. Controlling lymphedema involves diligent and concise type of care of the affected limb.



Symptoms


Lymphedema symptoms include:

¡ Swelling of part of your arm or your entire arm or leg, including your fingers or toes:

¡ A feeling of heaviness or tightness in your arm or leg:

¡ Restricted range of motion in your arm or leg:

¡ Aching or discomfort in your arm or leg:

¡ Recurring infections in your affected limb:

¡ Hardening and thickening of the skin on your arm or leg.

The lymphatic system is part of your immune system, which protects you against infection and disease. It includes your spleen, thymus, bone marrow, lymph nodes and lymph channels, as well as your tonsils and adenoids.






Causes of Lymphedema

The lymphatic system is crucial to keeping the body healthy. It circulates protein-rich lymph fluid throughout, collecting bacteria, viruses and waste products. The lymphatic system carries these through lymph vessels, which lead to lymph nodes. The wastes are then filtered out by lymphocytes — infection-fighting cells that live in the lymph nodes — and ultimately flushed from the body.

Lymphedema occurs when your lymph vessels are unable to adequately drain lymph fluid from your arm or leg. Lymphedema can be either primary or secondary. This means it can occur on its own (primary lymphedema) or it can be caused by another disease or condition (secondary lymphedema).

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Causes of primary lymphedemaPrimary lymphedema is a rare, inherited condition caused by problems with the development of lymph vessels in your body. Primary lymphedema occurs most frequently in women and usually affects the legs, rather than the arms. Specific causes of primary lymphedema include:

■ Milroy disease (congenital lymphedema). This is an inherited disorder that begins in infancy and causes a malformation of the lymph nodes, leading to lymphedema.

■ Meige disease (lymphedema praecox). This hereditary disorder causes lymphedema in childhood or around puberty. It causes lymph vessels to form without the valves that keep lymph fluid from flowing backwards, making it difficult for the body to properly drain the lymph fluid from limbs.

■ Late-onset lymphedema (lymphedema tarda). This occurs rarely and usually begins after age 35.

Causes of Secondary LymphedemaAny condition or procedure that damages lymph nodes or lymph vessels can cause lymphedema. Causes include:

■ Surgery can cause lymphedema to develop if lymph nodes and lymph vessels are removed or severed. For instance, surgery for breast cancer may include the removal of one or more lymph nodes in the armpit to look for evidence that cancer has spread. If remaining lymph nodes and lymph vessels can't compensate for those that have been removed, lymphedema may result in the arm.

■ Radiation treatment for cancer can cause scarring and inflammation of the lymph nodes or lymph vessels, restricting flow of the lymph.

■ Cancer cells can cause lymphedema if they block lymphatic vessels. For instance, a tumor growing near a lymph node or lymph vessel could become large enough to obstruct the flow of the lymph fluid.

■ Infection can infiltrate lymph vessels and lymph nodes, restricting the flow of lymph fluid and causing lymphedema. Parasites also can block lymph vessels. Infection-related lymphedema is most common in tropical and subtropical regions of the globe and is more likely to occur in undeveloped countries.

■ Injury that damages your lymph nodes or lymph vessels also can cause lymphedema.

If you're at risk of lymphedema — for instance, if you'verecently had cancer surgery involving your lymph nodes — your doctor may assume you have lymphedema based on your signs and symptoms.

If the cause of your lymphedema isn't as obvious, your doctor may order imaging tests to determine what's causing your signs and symptoms. To get a look at your lymphatic system, your doctor may use an imaging technique, such as:

■ Radionuclide imaging of your lymphatic system (lymphoscintigraphy). During this test you're injected with a radioactive dye and then scanned by a machine. The resulting images show the dye moving through your lymph vessels, highlighting areas where the lymph fluid is blocked.

■ Magnetic resonance imaging (MRI). This scan gives your doctor a better look at the tissues in your arm or leg. He or she might be able to use an MRI to see characteristics of lymphedema.

■ Computerized tomography (CT). A CT scan produces images of your arm or leg in cross sections.

■ Doppler ultrasound. This variation of the conventional ultrasound assesses blood flow and pressure by bouncing high-frequency sound waves (ultrasound) off red blood cells.





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