Lymphedema Diagnostic workup and management

Ayman A. Grada, and Tania J. Phillips. J Am Acad Dermatol 2017;77:995-1006

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Lymphedema Diagnostic workup and management

Ayman A. Grada, and Tania J. Phillips. J Am Acad Dermatol 2017;77:995-1006

Lymphedema is a localized form of tissue swelling resulting from excessive retention of lymphatic fluid in the interstitial compartment. It is caused by impaired lymphatic drainage. Lymphedema is a chronic progressive disease with serious physical and psychosocial implications. It can be challenging to diagnose, especially in obese patients and in those with coexisting venous disease. We performed PubMed and Google Scholar searches of the English-language literature (1966-2017) using the terms lymphedema, lymphedema management, and lymphatic complications. Relevant publications were manually reviewed for additional resources. There are currently no standard guidelines for the diagnosis of lymphedema. There is no cure yet for lymphedema, and the objective for management is to limit disease progression and prevent complications.

Main findings

The following are the key points for each topic covered.

Diagnosis

  • Lymphedema is a clinical diagnosis; other diagnostic tools can be used to rule out

other causes of extremity swelling.

  • Lymphoscintigraphy is the criterion standard imaging tool to confirm diagnosis.
  • Unless surgical intervention is considered, imaging is not necessary. This statement is interesting as they are using fluoroscopy to assist diagnosis.

Infants and young children presenting with lymphedema should have a chromosomal karyotyping or targeted variant analysis to test for Turner syndrome. Genetic testing should be considered for individuals with a family history of lymphedema.

Management

  • Early treatment is necessary to achieve better therapeutic outcomes

Compression is the mainstay of treatment

  • Meticulous skin care can prevent unwanted complications, such as cellulitis and ulceration
  • Combined decongestive therapy should be individualized for each patient, and close follow-up is necessary.
  • Advanced pneumatic compression devices are reliable and cost-effective alternatives or adjuncts to traditional treatment modalities
  • Diuretics have no role in lymphedema management.
  • Surgical intervention is only considered when conservative treatment is unsuccessful.
  • Effective communication improves patient compliance.