Tiwari A, Cheng KS, Button M, Myint F, Hamilton G, et al.
Archives of surgery (Chicago, Ill. : 1960). Date of publication 2003 Feb 1;volume 138(2):152-61.
1. Arch Surg. 2003 Feb;138(2):152-61.
Differential diagnosis, investigation, and current treatment of lower limb
lymphedema.
Tiwari A(1), Cheng KS, Button M, Myint F, Hamilton G.
Author information:
(1)University Department of Surgery, Royal Free Hospital National Health Service
Trust, London, NW3 2QG England.
HYPOTHESIS: The causes and management of lower limb lymphedema in the Western
population are different from those in the developing world.
OBJECTIVE: To look at the differential diagnosis, methods of investigation, and
available treatments for lower limb lymphedema in the West.
DATA SOURCE: A PubMed search was conducted for the years 1980-2002 with the
keyword "lymphedema." English language and human subject abstracts only were
analyzed, and only those articles dealing with lower limb lymphedema were further
reviewed. Other articles were extracted from cross-referencing.
RESULTS: Four hundred twenty-five review articles pertaining to lymphedema were
initially examined. This review summarizes the findings of relevant articles
along with our own practice regarding the management of lymphedema.
CONCLUSIONS: The common differential diagnosis in Western patients with lower
limb swelling is secondary lymphedema, venous disease, lipedema, and adverse
reaction to ipsilateral limb surgery. Lymphedema can be confirmed by a
lymphoscintigram, computed tomography, magnetic resonance imaging, or ultrasound.
The lymphatic anatomy is demonstrated with lymphoscintigraphy, which is
particularly indicated if surgical intervention is being considered. The
treatment of choice for lymphedema is multidisciplinary. In the first instance,
combined physical therapy should be commenced (complete decongestive therapy),
with surgery reserved for a small number of cases.
PMID: 12578410 [Indexed for MEDLINE]
