General Overview

Abstract

Edema develops whenever the transport rate of interstitial fluid through the lymphatic vasculature is unable to accommodate the rate of interstitial fluid production. Adequate lymphatic function is central to the avoidance of tissue edema. The clinical diagnosis of lymphedema should be reserved for patients in whom there is objectively documented reduction in lymphatic clearance or in whom the classic cutaneous changes of the lymphedema can be demonstrated.

• In lymphedema, the skin thickens and presents a rough texture. Histologically, lymphedema is characterized by epidermal atrophy, dermal fibrosis, variable degrees of dermal edema, and abundant subcutaneous fat with prominent fibrous septations.

• Clinical signs and symptoms of lymphedema are influenced by the duration and the severity of the disease.

• In early-stage lymphedema, the edema pits easily and remits or resolves with elevation of the affected limb. Later, the attribute of pitting edema diminishes and may disappear entirely: elevation and compression progressively become less effective at reducing the excess limb volume.

• Proliferation of dermal and subdermal connective and adipose tissue creates cutaneous thickening and loss of normal elasticity.

• Most of the features of chronic lymphedema can be identified by inspection and palpation of the skin of the affected limb(s).

• In the lower extremities, thickening of the skin at the base of the digits can produce a positive Stemmer’s sign and characteristic involvement of the digits.

• Characteristic physical findings of chronic lymphedema include peau d’orange changes, hyperkeratosis, papillomatosis, cobblestone deformities, lymph cysts, and chronic inflammatory changes.

• The differential diagnosis of lymphedema includes any pathological condition that predisposes to edema through distortion of the Starling forces.