Lymphedema is diagnosed clinically through patient history and physical examination. It occurs when lymphatic fluid accumulates in the skin and tissues, stimulating fibroblasts and deposition of collagen. Diagnostic imaging tools include lymphoscintigraphy, MRI lymphography, and CT scans to visualize lymphatic structures and evaluate function. Treatment involves meticulous skin care combined with physical therapy, compression garments, and surgery such as lymph node transplantation or lymphatic-venous bypass to restore lymphatic drainage.
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How to Diagnose and Treatment For Lymphoedma?
1. How to Diagnose and Treatment of
Lymphoedma?
http://muh.org.au/services-specialties/lymphoedema-program/phases
2. Diagnosis
An accurate diagnosis of lymphedema is essential for appropriate
therapy. In most patients, the diagnosis of lymphedema can be readily
determined from the clinical history and physical examination. In other
patients confounding conditions such as morbid obesity, lipodystrophy,
endocrine dysfunction, venous insufficiency, occult trauma, and
repeated infection may complicate the clinical picture.
3. Pathology
Lymphedema occurs from the accumulation of interstitial and lymphatic
fluid within the skin and subcutaneous tissue. This then stimulates
fibroblasts, keratinocytes and adipocytes which in turn result in
deposition of collagen and glycosaminoglycans within the skin and
subcutaneous tissue which could then lead to skin hypertrophy and
destruction of elastic fibres.
4. Imaging
Ddynamic images of both lymphatics and lymph nodes in the peripheral
and central system as well as semiquantitative data on radiotracer
(lymph) transport, and it does not require dermal injections of blue-dye
(as often used for example in axillary or groin sentinel node visualization
i.e., lymphadenoscintigraphy). Dye injection is occasionally complicated
by an allergic skin reaction or serious anaphylaxis.
5. Lymphoscintigraphy
Lymphoscintigraphy is commonly used for confirming the diagnosis of
lymphedema and is a reliable method for functional assessment of the
lymphatic system. It affords visualisation of the major lymphatic trunks
and lymph nodes as well as evaluation of lymphatic function.
6. Magnetic Resonance Lymphography
Magnetic resonance lymphography (MRL) entails the acquisition of
high-resolution 3D datasets of the entire limb. It is especially useful for
preoperative planning of lymphaticovenular anastomosis (LVA)
microsurgery, as it can demonstrate individual lymphatic channels and
areas of dermal backflow.
7. Computed Tomography
CT can be used to localise oedema as subfascial or epifascial and
depict the characteristic honeycomb pattern of subcutaneous oedema
and skin thickening. Its role in follow-up is diminishing, though, owing to
its inherent ionising radiation.
8. Treatment For Lymphoedma
Therapy of peripheral lymphedema is divided into conservative (non-
operative) and operative methods. Applicable to both methods is an
understanding that meticulous skin hygiene and care (cleansing, low pH
lotions, emollients) is of upmost importance to the success of virtually all
treatment approaches.
9. Treatment of Lymphoedma
A. Non-operative Treatment
Physical therapy and adjuvants
Drug therapy
Psychosocial rehabilitation
B. Operative Treatment
Microsurgical procedures
Liposuction
Surgical Resection
Lymph Node Transplantation
Special Considerations
C. Treatment Assessment
D. Molecular Therapy
