Lymphoedema

Question 1

Outline the pathogenesis of lymphoedema

Answer 1

• Disrupted lymph nodes/vessels cause lymph stasis and accumulation.
• High extracellular protein concentrations cause inflammation and fibrosis - further damage results

Question 2

What are the risk factors/likely history findings in a patient with suspected lymphoedema?

Answer 2

• Breast cancer treatment
• Nematode infection
• Surgery near axillary/inguinal lymph nodes
• Advanced tumour
• Radiotherapy
• Trauma

Question 3

What signs are likely to be found on examination in a patient with lymphoedema?

Answer 3

• Unilateral, non-pitting oedema

Question 4

What investigations might be warranted to work up a suspected case of lymphoedema?

Answer 4

• Lymphoscintogram
• MRI if malignancy suspected

Question 5

What are the management prinicples of lymphoedema?

Answer 5

• Management of excessive lymph
  
  • Compression bandaging or garments, elevation, exercise, manual lymph drainage, pneumatic compression
• Management of complications
  
  • Skin care (moisturising, bathing)