Abnormal collection of protein-rich fluid in the interstitium from obstructed lymphatic drainage.

Clinical presentation

• Chronic swelling of a limb – lower limbs in 80%, also arms, face, genitalia and trunk.

• Fever, chills and weakness; severe limitation of daily activities.

• Recurrent bacterial or fungal infection, cellulitis, lymphangitis, fissures, ulcers or warty changes.

Investigations

• Lymphoscintigraphy (reference standard); Doppler ultrasound; CT angiography; MR angiography.

Management

Goals: restore limb function, reduce swelling and its physical and psychological effects, prevent infections, treat the cause of secondary lymphoedema, and support weight control and activity.

• Hygiene and skin care.

• Complex physical therapy (first line) and compression stockings.

• Weight loss if overweight; avoid trauma and tight clothing; elevate the limb.

• Surgery for selected refractory cases to reduce limb volume and improve drainage – palliative, always alongside continued compression and skin care.