Lymphoedema !
Lymphoedema is long-lasting swelling of a limb because the lymphatic system cannot drain fluid from the tissues.
Updated 2026-10-29
Structures involved
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- Crural fascia
- Fascia lata
- Great saphenous vein
- Top-of-foot veins
- Second toe
- Inguinal ligament
- Femoral vein
Microorganisms that cause it
In immunology
In histology
In the clinical exam
In physiology
Why it happens
What it is
Chronic swelling of a limb caused by build-up of protein-rich fluid in the tissues because the lymphatic system cannot drain it.
Who gets it
Worldwide, lymphatic filariasis is a leading cause of secondary lymphoedema in tropical countries. Elsewhere, cancer treatment is the main cause; primary forms are rare.
Causes
- Primary: developmental abnormalities of lymphatic vessels (congenital, praecox at puberty, tarda in adulthood), sometimes familial (Milroy disease)
- Secondary: lymph node dissection or radiotherapy for cancer (pelvic, gynaecological, melanoma)
- Lymphatic filariasis (Wuchereria bancrofti)
- Recurrent cellulitis, trauma and chronic venous insufficiency
- Obesity and tumour obstruction of lymph nodes
Risk factors
- Lymph node dissection or radiotherapy
- Obesity
- Recurrent cellulitis
- Living in or coming from areas endemic for filariasis
- Family history (primary forms)
Pathophysiology
When lymphatic transport falls below the fluid that leaves the capillaries, protein-rich fluid builds up in the tissues. The protein triggers inflammation, fat deposition and fibrosis, so soft pitting swelling slowly turns into firm, non-pitting swelling with thickened skin.
Classification
- Primary versus secondary
- ISL stages: 0 latent, I reversible with elevation, II pitting that does not resolve with elevation, III lymphostatic elephantiasis with skin changes
Symptoms and signs
- Slowly progressive swelling, often starting in the foot and toes
- Heaviness and tightness of the limb
- Positive Stemmer sign: the skin on the back of the second toe cannot be pinched
- Pitting early, then non-pitting firm swelling
- Thickened skin, papillomatosis and skin folds in advanced stages
Diagnosis
- Clinical
- History (surgery, radiotherapy, travel or residence, infections) and examination, with Stemmer sign and limb measurements.
- Tests
- Blood tests to exclude heart, kidney, liver or thyroid causes of oedema; filarial antigen testing or a night blood smear where filariasis is possible.
- Imaging
- Lymphoscintigraphy confirms impaired lymph flow; Doppler ultrasound excludes venous disease; MRI or CT if a tumour is suspected.
Differential diagnosis
- Chronic venous insufficiency
- Lipoedema (symmetric, spares the feet)
- Deep vein thrombosis
- Heart, kidney or liver failure
- Hypothyroidism (myxoedema)
- Drug-induced oedema
Goal of treatment
Reduce limb volume, keep the reduction, prevent infection and preserve function and quality of life; there is no cure.
Treatment
- Conservative
- Complete decongestive therapy: manual lymphatic drainage, multilayer compression bandaging, exercise and skin care, followed by compression garments.
- Lifestyle
- Skin hygiene, prompt care of cuts, weight control and regular exercise.
- Medical
- Antibiotics for cellulitis and, if attacks recur, as prophylaxis; antiparasitic drugs for filariasis in mass drug administration programmes.
- Surgical
- Lymphovenous anastomosis, lymph node transfer or debulking (liposuction) in selected patients at specialised centres.
Complications
- Recurrent cellulitis
- Skin thickening, lymphorrhoea and wounds
- Reduced mobility and psychological distress
- Lymphangiosarcoma (Stewart-Treves syndrome, rare)
Prognosis
A lifelong condition. Early decongestive therapy and lasting compression can control swelling well, while untreated disease tends to progress.
Prevention
- Sentinel node techniques that reduce lymph node dissection
- Early detection after cancer treatment
- Skin care and prompt treatment of infections
- Filariasis elimination programmes and vector control
Test yourself
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What is the difference between primary and secondary lymphoedema?
Primary comes from a developmental lymphatic abnormality; secondary from damage such as surgery, radiotherapy, infection or filariasis.
What is the leading cause of secondary lymphoedema worldwide?
Lymphatic filariasis, mainly caused by Wuchereria bancrofti.
What is a positive Stemmer sign?
Inability to pinch the skin on the back of the second toe (or finger), suggestive of lymphoedema.
What is the mainstay of lymphoedema treatment?
Complete decongestive therapy: manual lymphatic drainage, compression, exercise and skin care.
Which infection is the most common complication of lymphoedema?
Cellulitis, which can recur and worsen the lymphatic damage.
Related conditions
- Cellulitis of the leg
- Chronic venous insufficiency
- Deep vein thrombosis
- Obesity
- Cervical cancer
- Hypothyroidism
- Varicose veins
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Lymphedema (StatPearls (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.
