Lymphedema

Alan Frischer, MD, MPH

Oct 9

2 min read

Swelling in the legs or arms may mean that you are suffering from lymphedema. The swelling is caused by fluid that is usually drained through the body’s lymphatic system. Swelling can also occur in the chest wall, abdomen, neck and genitals. (Do note that there are other reasons for leg and arm swelling, including congestive heart failure, liver and kidney failure, and deep vein thrombosis.)

The lymphatic system consists of lymph fluids, lymphatic vessels, lymph nodes, and organs (the spleen, thymus, tonsils, and bones). Lymph nodes act as filters and contain cells that fight infection and cancer. The system collects excess fluid, proteins and toxins from cells and tissues and returns them to the bloodstream. Lymph fluid is pushed through the lymph vessels by muscle contractions, and any problem that blocks drainage can cause lymphedema.

Symptoms include swelling of part or all of the arm or leg, a feeling of heaviness or tightness, restricted range of motion, recurring infections, or hardening and thickening of the skin (fibrosis).

Why might lymphedema occur?

Breast or pelvic surgery sometimes includes removing lymph nodes.
Radiation therapy may cause scarring and damage to the lymphatic system.
Tumors may block lymphatic drainage.
Trauma to an area of the body may damage the network of lymphatic vessels.
An infection may damage the lymphatic system.
Obesity can lead to excess fat tissue putting pressure on lymph nodes and vessels.
Lack of activity may affect the ability of the leg muscles to pump up lymphatic circulation.
Heart issues, particularly congestive heart failure, may cause lymphedema. The lymphatic ducts empty lymph back into the heart, and if the heart isn’t working properly, lymphedema could then cause weight gain or swollen legs.
Chronic blood vessel issues may cause lymphedema, because blood vessels carry between 80% and 90% of fluid throughout the body.
Poor kidney function makes it difficult for the body to remove extra fluid and waste products. Swelling from this excess fluid may lead to lymphedema.
In developing countries, parasites are the most common cause of lymphedema, due to threadlike worms that clog the lymph nodes.

The most common risk factors that increase the risk of developing lymphedema include age, excess weight, and rheumatoid or psoriatic arthritis.

A diagnosis of lymphedema is made through a careful history, and sometimes imaging including ultrasound, MRI, and CT scan. Prevention focuses on eating a healthy low salt diet, and incorporating exercise.

There is no cure for lymphedema. Treatment depends on the cause, and may include physical therapy to keep lymphatic fluids moving and to reduce swelling and pain. Antibiotics are prescribed if there are signs of skin infection. Other treatments include compression stockings or bandages, massage, sequential pneumatic pumping, skin care, elevation, and exercise. Very rarely, surgery may be used to remove swollen tissue or to create new drainage routes.