 |
|
Differential Diagnosis, Investigation, and Current Treatment of Lower Limb Lymphedema
Alok Tiwari, MRCSEd;
Koon-Sung Cheng, FRCS;
Matthew Button, MRCS;
Fiona Myint, FRCS;
George Hamilton, FRCS
Arch Surg. 2003;138:152-161.
Hypothesis The causes and management of lower limb lymphedema in the Western population are different from those in the developing world.
Objective To look at the differential diagnosis, methods of investigation, and available treatments for lower limb lymphedema in the West.
Data Source A PubMed search was conducted for the years 1980-2002 with the keyword "lymphedema." English language and human subject abstracts only were analyzed, and only those articles dealing with lower limb lymphedema were further reviewed. Other articles were extracted from cross-referencing.
Results Four hundred twenty-five review articles pertaining to lymphedema were initially examined. This review summarizes the findings of relevant articles along with our own practice regarding the management of lymphedema.
Conclusions The common differential diagnosis in Western patients with lower limb swelling is secondary lymphedema, venous disease, lipedema, and adverse reaction to ipsilateral limb surgery. Lymphedema can be confirmed by a lymphoscintigram, computed tomography, magnetic resonance imaging, or ultrasound. The lymphatic anatomy is demonstrated with lymphoscintigraphy, which is particularly indicated if surgical intervention is being considered. The treatment of choice for lymphedema is multidisciplinary. In the first instance, combined physical therapy should be commenced (complete decongestive therapy), with surgery reserved for a small number of cases.
From the University Department of Surgery, Royal Free Hospital National Health Service (NHS) Trust (Drs Tiwari, Cheng, Button, Myint, and Hamilton); and North Middlesex University Hospital NHS Trust (Dr Myint), London, England.
RELATED ARTICLE
This Month in Archives of Surgery
Arch Surg. 2003;138(2):125.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
New Horizons for Imaging Lymphatic Function
SHARMA et al.
Ann. N. Y. Acad. Sci. 2008;1131:13-36.
ABSTRACT
| FULL TEXT
Is there a risk for lymphatic complications after endovenous laser treatment versus cryostripping of the great saphenous vein? A prospective study
Disselhoff et al.
Phlebology 2008;23:10-14.
ABSTRACT
| FULL TEXT
Lymphedema of the Lower Extremity: Is It Genetic or Nongenetic?
Shinawi
CLIN PEDIATR 2007;46:835-841.
ABSTRACT
Quantitative imaging of lymph function
Sharma et al.
Am. J. Physiol. Heart Circ. Physiol. 2007;292:H3109-H3118.
ABSTRACT
| FULL TEXT
Pearls and pitfalls of radionuclide imaging of the lymphatic system. Part 2: evaluation of extremity lymphoedema
Scarsbrook et al.
Br. J. Radiol. 2007;80:219-226.
ABSTRACT
| FULL TEXT
Elephantiasis nostras verrucosa.
Yoho et al.
J. Am. Podiatr. Med. Assoc. 2006;96:442-444.
ABSTRACT
| FULL TEXT
Approach to Leg Edema of Unclear Etiology
Ely et al.
J Am Board Fam Med 2006;19:148-160.
ABSTRACT
| FULL TEXT
|
