Lymphedema is a chronic, progressive disease characterized by swelling, fat deposition, and fibrosis in one or multiple extremities. It results from dysfunction or disruption to the lymphatic system. The lymphatic system is responsible for transporting fluid through our tissues, and it also filters the fluid for any bacteria or cancer cells and alerts the immune system to fight them.

There are two types of lymphedema. Primary lymphedema is often inherited or congenital. Secondary lymphedema is an acquired condition that is the result of damage to the lymphatic system. In the Unites States, the most common cause of lymphedema is secondary to surgery such as lymph node removal in cancer patients, which is often worsened by radiation therapy. The risk of developing lymphedema can be as high as 35% in certain cases after lymph node dissection.

WHAT ARE THE RISK FACTORS FOR SECONDARY LYMPHEDEMA?

Many factors can impact an individuals risk for developing lymphedema. The most common include obesity or high body mass index (BMI), lymph node dissection, radiation, arteriovenous fistulas for dialysis, vein compression or occlusion, history of soft tissue infections, chemotherapy, and other medical conditions.

HOW IS LYMPHEDEMA DIAGNOSED?

The gold-standard diagnostic test for lymphedema is a lymphoscintigram. This exam is performed by Nuclear Medicine. A tracer is injected into the hands or feet, and the uptake of the tracer is compared between the right and left side. Slow or absent uptake and areas of dermal backflow are consistent with the diagnosis of lymphedema.

Once the diagnosis has been confirmed, other studies may be ordered to assess the lymphatic system in the affected extremity for surgical planning. These include magnetic resonance lymphangiograms (MRLs) or indocyanine green lymphangiography (ICG lymphangiography).