lower extremity lymphedema
Introduction
Introduction to lower limb lymphedema Local edema caused by lymphatic reflux disorder, called lymphedema. For some reasons, lymph fluid can accumulate in the subcutaneous tissue, which in turn causes fibrosis, fatty sclerosis, limb swelling in the later stage, thickening and rough skin, and it is as skin-like, so it is also called "skin-like swelling." It can occur in the external genitalia and limbs, and the lower extremities are most common. The main manifestation is swelling of one limb, starting at the ankle and foot, and later involving the entire lower limb. The early protein-rich lymph fluid accumulates in the interstitial space, forming soft depressed edema and normal skin. In the late stage, due to the concentration of protein accumulated in the interstitial space, inflammation and fibrosis of the subcutaneous tissue, the edema is non-depressed, the skin is thickened, dry, rough, pigmented, and tendons or spines appear. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: nausea and vomiting
Cause
Causes of lower extremity lymphedema
Primary lymphedema (45%):
Mostly caused by lymphatic dysplasia, most of them are lymphatic dysplasia, and a few are enlarged lymphatic abnormalities.
Secondary lymphedema (35%):
Lymphatic obstruction due to certain diseases.
Primary lymphedema
According to lymphangiography, primary lymphedema can be classified as follows: 1 lymphatic hypoplasia with subcutaneous lymphoid deficiency; 2 lymphatic hypoplasia, small lymph nodes and lymphatic vessels; 3 lymphoid hyperplasia with lymph nodes and lymphatic vessels More, there are times of distortion and varicose. Lymphatic hypoplasia is very rare, common in congenital lymphedema. Development is lower than the most common type. Both simple and atrophic lymphedema are congenital. Early onset lymphedema is more common in adolescent women or young women, and the symptoms are aggravated during menstruation. Therefore, the cause may be related to endocrine disorders, accounting for 85-90% of primary lymphedema. After the onset of 35 years old, it is called delayed lymphedema.
Secondary lymphedema
Common filament infections are now rare, and streptococcal infections and radiation therapy and lymph node dissection for cancer are the main causes of lymphedema.
Secondary lymphedema is mostly caused by blockage of lymphatic vessels. The most common in China is filariasis lymphedema and streptococcal infectious lymphedema. Upper extremity lymphedema after breast cancer radical surgery is not uncommon.
Although Herophilos and Aristotle have observed the lymphatic system as early as the third and fourth centuries, a lot of experimental studies have been done in modern times, but the exact pathogenesis of lymphedema is unclear.
Prevention
Lower limb lymphedema prevention
The prevention and control of mosquitoes and filariasis is the main measure to prevent lymphatic edema caused by filamentous infection. For lymphangitis caused by hemolytic streptococcal infection, the initial attack should be thoroughly treated, the amount of antibiotics should be sufficient, and the course of treatment should be extended. Athlete's foot is a common factor in the invasion of pathogenic bacteria and should be actively treated.
Complication
Lower limb lymphedema complications Complications, nausea and vomiting
Incision infection, systemic reaction: nausea, vomiting, fever, etc.
Symptom
Lower extremity lymphedema symptoms Common symptoms Lower extremity swelling and weak skin muscle thickening, fibrotic skin rough pregnant women leg cramps
1. The early limbs are swollen, the affected limbs are swollen in the late stage, the surface is keratinized, and the rubber is swollen.
2. A small number of skin cracks, ulcers or sickle-like creatures.
Examine
Examination of lower limb lymphedema
[Auxiliary inspection]
(A) Diagnostic puncture tissue fluid analysis: analysis of subcutaneous edema tissue fluid, help differential diagnosis of difficult cases. The protein content of lymphedema fluid is usually very high, generally 1.0-5.5 g/dl, and the edema tissue fluid protein content of simple venous stasis, heart failure or hypoproteinemia is 0.1-0.9 g/dl. The examination is usually used for chronically large swollen limbs, which can be operated with only a syringe and a fine needle. The method is simple and convenient. However, it is impossible to understand the location and function of lymphatic vessels. It is a rough diagnosis.
(B) lymphangiography: lymphatic vessel puncture injection of contrast agent, the film shows a method of examination of the lymphatic morphology, is a specific auxiliary examination of lymphedema.
Diagnosis
Diagnosis and identification of lower extremity lymphedema
diagnosis
1. There is a history of recurrent episodes of filarial infection or erysipelas, or a history of axillary and inguinal lymph node dissection and radiotherapy.
2. The early limbs are swollen and can be relieved after raising. In the advanced stage, the affected limb was swollen, the surface was rough and the rubber was swollen. A few may have skin cracking, ulceration or sickle-like creatures.
3. Microfilariae can be found in blood tests around the infected person of the filaria. Lymphangiography can determine lymphatic development or obstruction.
[Differential diagnosis]
Early changes in skin and subcutaneous tissue should be differentiated from other diseases:
1. Venous edema: more common in deep venous thrombosis of the lower extremity, acute onset of unilateral limb sudden swelling, with skin color cyanosis, gastrocnemius and femoral triangle obvious tenderness, superficial vein exposure as its clinical features, dorsal edema Not obvious. Lymphedema is slower onset, and it is more common to swollen the back of the foot.
2. Angioedema: Edema occurs in the stimulation of external allergic factors, rapid onset, rapid regression, and intermittent seizures. Lymphedema is gradually increasing.
3. Systemic diseases: hypoproteinemia, heart failure, kidney disease, cirrhosis, mucinous edema, etc. can produce lower extremity edema. It is generally bilaterally symmetrical with clinical manifestations of the respective primary disease. It is usually identified by detailed medical history, careful physical examination and necessary laboratory tests.
4. Congenital arteriovenous fistula: congenital arteriovenous fistula can be manifested as limb edema, but the general limb length and circumference are larger than the healthy side, skin temperature is increased, superficial varicose veins, local area can be heard and vascular murmur, peripheral vein The blood oxygen content is close to the arterial blood oxygen content. All of the above are their unique features.
5. Lipoma: A small number of lipomas or adipose tissue hyperplasia with a wide range of lesions can be confused with lymphedema. However, most of the lipomas have localized growth, the course of disease is slow, and the subcutaneous tissue is soft and edema. If necessary, soft tissue X-ray mammography can be used to help confirm the diagnosis.
