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Differential Diagnosis Of Lymphedema

LYMPHEDEMA CALLED PODOCNOIOSIS:  This is lymphedema caused by walking barefoot or direct exposure to the clay soils of Ethiopia.

LIPEDEMA:  a symmetrical “swelling” of both legs, extending from the hips to the ankles, caused by deposits of subcutaneous adipose (fatty) tissue.  The underlying etiology of these fat deposits remains unknown.  While lipedema is not a disorder of the lymphatic system per se, it is frequently confused with bilateral lower extremity lymphedema. 

It occurs almost exclusively in women and may have an associated hormonal disorder as well.  If present in a man, it is accompanied by massive hormonal disorder.  Fat in the lower extremities extends to the ankle bones often with flaps of tissue hanging over the foot.  The feet are not affected; occasionally, lipedema is found in the arms.  Typically, there are also fatty bulges in the medial proximal thigh and the medial distal thigh, just above the knee.

STEWART-TREVES SYNDROME (STS) is a rare form of lymphangiosarcoma that occurs as a complication of lymphedema.  The lymphedematous region becomes an immunologically vunerable area that is predisposed to malignancy. 

MILROY’S DISEASE is a familial disease characterized by lymphedema, commonly in the legs, caused by congenital abnormalities in the lymphatic system.  Disruption of the normal drainage of lymph leads to fluid accumulation and hypertrophy of soft tissues. 

The defect in Milroy’s disease is present from birth and symptoms are usually first experienced in childhood.  The most common problem is one-sided leg swelling, unilateral edema, which is progressive and can affect both legs. 

This disease is more common in women and is an association with the gene FLT4.

Diagnostic Test for Lymphedema

Although most cases of lymphedema are diagnosed on a patient's history and clinical findings.

Lymphoscintigraphy (isotope lymphography)  is now considered to be the best technique for evaluating lymphatic function and for differentiating causes of lymphedema.  It is minimally invasive and does not damage the lymph vessels as they are being visualized.

The Lymphatic System

The  lymph system consists of a network of lymph vessels carrying lymph fluid to lymph nodes.  The lymph vessels are located all over the body (usually next to veins) and transport lymph fluid  -  excess fluid in the tissues which is filled with proteins, white blood cells, germs and cellular waste products.  This fluid is carried up to the lymph nodes where it is filtered and detoxified, before being returned to the blood stream.



There are  500-1000 lymph nodes located all around the body:

  • The neck (supraclavicular and cervical)                 The armpits (axilla)
          • Along the windpipe (trachea)                                  Adjacent to the lung (bronchial)
  • In the chest cavity (thoracic)                                   Along the intestine (abdominal)
  • Behind the abdominal cavity (retroperitoneal)        
  • The pelvic area - The groin area (inguinal)

Lymph tissue is also found in the tonsils, spleen, intestinal wall and bone marrow.