Section 25 Lymphedema

Question 1

Classification of primary lymphedema?

Answer 1

Primary lymphedema is further classified on the basis of genetics (familial vs. sporadic) and time of onset (congenital, praecox, tarda).

Question 2

Time classification of primery lymphedema?

Answer 2

Congenital - present at birth or is recognized within the first year of life.

Praecox/Meige’s disease (most common) - onset of puberty until the third decade.

Tarda (10%) - after the age of 35 years

Question 3

What is the most common cause of lymphedema in the western world?

Answer 3

Secondary.

Iatrogenic causes predominate.

Question 4

What is the most common cause of lymphedema in the third world?

Answer 4

Secondary.

90% Filariasis - Wuchereia bancrofti (90%).

Question 5

What are the clinical stages of lymphedema?

Answer 5

• Latent Phase: Excess fluid accumulates and fibrosis.No edema is apparent clinically.
• Grade I: Edema pits on pressure and is reduced largely or completely by elevation. No clinical evidence of fibrosis.
• Grade II: Edema does not pit on pressure and is not reduced by elevation. Moderate to severe fibrosis is evident on clinical examination.
• Grade III: Edema is irreversible and develops from repeated inflammatory attacks, fibrosis, and sclerosis of the skin and subcutaneous tissue. Elephantiasis.

Question 6

What is the differeance between lipedema and lymphedema?

Answer 6

Lipedema is characterized by the deposition of a large amount of fatty tissue in the subcutaneous layers.
involves both legs and there is a sparing of the feet despite pronounced enlargement of the calves and thighs.

Question 7

What is the gold standard and goal of treatment in lyphedema?

Answer 7

Mechanical therapy is the gold standard and includes self hygiene, compression techniques and physiotherapy.
Attention is directed to the reduction of limb swelling and prevention of secondary infections.