[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Lymphoedema [Conditions](https://durgical.com/en/conditions/) · [Lower limb](https://durgical.com/en/anatomy/region/lower-limb/) # Lymphoedema Lymphoedema is long-lasting swelling of a limb because the [lymphatic system](https://durgical.com/en/anatomy/system/lymphatic-system/) cannot drain fluid from the tissues. Updated 2026-10-29 ## Structures involved Tap one to see what it is and open it in 3D. - [Crural fascia](https://durgical.com/en/anatomy/crural-fascia/) - [Fascia lata](https://durgical.com/en/anatomy/fascia-lata/) - [Great saphenous vein](https://durgical.com/en/anatomy/great-saphenous-vein/) - [Top-of-foot veins](https://durgical.com/en/anatomy/dorsal-venous-arch-of-foot/) - [Second toe](https://durgical.com/en/anatomy/second-toe/) - [Inguinal ligament](https://durgical.com/en/anatomy/inguinal-ligament/) - [Femoral vein](https://durgical.com/en/anatomy/femoral-vein/) ## Microorganisms that cause it - [Wuchereria bancrofti / Brugia malayi](https://durgical.com/en/microbiology/wuchereria-bancrofti-brugia-malayi/) ## In immunology - [Lymph node: cortex, paracortex, medulla](https://durgical.com/en/immunology/lymph-node-cortex-paracortex-medulla/) ## In histology - [Lymphatic vessels](https://durgical.com/en/histology/lymphatic-vessels/) ## In the clinical exam - [Edema: pitting, grading and distribution](https://durgical.com/en/clinical-exam/edema-pitting-grading-and-distribution/) ## In physiology - [Starling forces at the capillary](https://durgical.com/en/physiology/starling-forces-at-the-capillary/) - [How edema forms](https://durgical.com/en/physiology/how-edema-forms/) - [How the lymphatic system works](https://durgical.com/en/physiology/how-the-lymphatic-system-works/) ## Why it happens - [Edema and effusions: the four mechanisms](https://durgical.com/en/general-pathology/edema-and-effusions-the-four-mechanisms/) ## 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](https://durgical.com/en/anatomy/second-toe/) cannot be pinched - Pitting early, then non-pitting firm swelling - Thickened skin, papillomatosis and skin folds in advanced stages ## Red flags - Fever, redness and pain in the limb (cellulitis) - Sudden swelling of one limb (deep vein thrombosis) - New swelling after cancer treatment, which can mean recurrence - Purple skin lesions in a long-standing lymphoedema (lymphangiosarcoma, rare) ## Diagnosis **Clinical** History (surgery, radiotherapy, travel or residence, infections) and examination, with Stemmer sign and limb measurements. **Tests** Blood tests to exclude heart, [kidney](https://durgical.com/en/anatomy/kidney/), [liver](https://durgical.com/en/anatomy/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](https://durgical.com/en/anatomy/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 Think of the answer, then tap the question to see it. ## 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. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/lymphoedema/) ## Related conditions - [Cellulitis of the leg](https://durgical.com/en/conditions/cellulitis-of-the-leg/) - [Chronic venous insufficiency](https://durgical.com/en/conditions/chronic-venous-insufficiency/) - [Deep vein thrombosis](https://durgical.com/en/conditions/deep-vein-thrombosis/) - [Obesity](https://durgical.com/en/conditions/obesity/) - [Cervical cancer](https://durgical.com/en/conditions/cervical-cancer/) - [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/) - [Varicose veins](https://durgical.com/en/conditions/varicose-veins/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Lymphedema](https://www.ncbi.nlm.nih.gov/books/NBK537239/) (StatPearls (NCBI Bookshelf), 2025). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/lymphoedema/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/lymphoedema/