Lymphedema - Revision history

ClaireLewis at 16:22, 29 September 2019

2019-09-29T16:22:58Z

← Older revision		Revision as of 16:22, 29 September 2019
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	** Recurrent Skin Infections (eg. [[cellulitis]], [[erysipelas]])		** Recurrent Skin Infections (eg. [[cellulitis]], [[erysipelas]])
	** [[Lymphadenitis]]		** [[Lymphadenitis]]
	* Obesity		* [[the obese patient\|Obesity]]
	* Inflammatory disorders		* Inflammatory disorders
	** Dermatitis		** Dermatitis
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	*** [[Rheumatoid arthritis]]		*** [[Rheumatoid arthritis]]
	*** [[Psoriatic arthritis]]		*** [[Psoriatic arthritis]]
	*** Juvenile Idiopathic Arthritis		*** [[Juvenile Idiopathic Arthritis]]

	==Clinical Features==		==Clinical Features==
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	* Rule out alternative diagnoses (e.g. duplexes to rule out DVT if indicated)		* Rule out alternative diagnoses (e.g. duplexes to rule out DVT if indicated)
	* Additional non-ED studies may include:		* Additional non-ED studies may include:
	** Duplex Ultrasound		** [[ultrasound: DVT\|Duplex Ultrasound]]
	** Lymphoscintigraphy		** Lymphoscintigraphy
	** Computed Tomography		** Computed Tomography

Rossdonaldson1 at 20:44, 26 March 2019

2019-03-26T20:44:32Z

@@ Line 37: / Line 37: @@
 ** Occurs due to cutaneous fibrosis and adipose deposition.
 * Stemmer Sign - positive if unable to pinch and lift skin at the base of second toe or finger.
 ===Clinical Staging (by International Society of Lymphology) <ref name="ISL">International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46:1-11</ref>===
@@ Line 84: / Line 67: @@
 ||[[File:4lymphedema.png|70px]]
 |}
 ==Management<ref>Rockson SG. Lymphedema. Am J Med 2001; 110:288-95</ref><ref name="ISL">International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46:1-11</ref>==

Rossdonaldson1: /* Evaluation */

2019-03-26T20:43:55Z

Evaluation

← Older revision		Revision as of 20:43, 26 March 2019
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	==Evaluation==		==Evaluation==
	* Diagnosis is primarily made clinically. See clinical features above.		===Workup===
	* Rule out alternative diagnoses (e.g. duplexes to rule out DVT if indicated)		* Rule out alternative diagnoses (e.g. duplexes to rule out DVT if indicated)
	* Additional non-ED studies may include:		* Additional non-ED studies may include:
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	** Indocyanine Green (ICG) Lymphangiography		** Indocyanine Green (ICG) Lymphangiography
	** Genetic Testing		** Genetic Testing

			===Diagnosis===
			* Diagnosis is primarily made clinically.

	===Clinical Staging (by International Society of Lymphology) <ref name="ISL">International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46:1-11</ref>===		===Clinical Staging (by International Society of Lymphology) <ref name="ISL">International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46:1-11</ref>===

Rossdonaldson1: /* Clinical Staging (by International Society of Lymphology) International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46:1-11 */

2019-03-26T20:39:13Z

Clinical Staging (by International Society of Lymphology) International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46:1-11

← Older revision		Revision as of 20:39, 26 March 2019
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	*Lymphostatic elephantiasis (pitting may be absent)		*Lymphostatic elephantiasis (pitting may be absent)
	*Skin changes such as fat deposits, acanthosis, warty overgrowths		*Skin changes such as fat deposits, acanthosis, warty overgrowths
	\|\|		\|\|[[File:4lymphedema.png\|70px]]
	\|}		\|}

Rossdonaldson1: /* Clinical Staging (by International Society of Lymphology) International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46:1-11 */

2019-03-26T20:38:10Z

← Older revision		Revision as of 20:38, 26 March 2019
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	*NOT reversible with limb elevation alone		*NOT reversible with limb elevation alone
	*Some dermal fibrosis present		*Some dermal fibrosis present
	\|\|[[File:2lymphedema.png\|70px]]		\|\|[[File:2lymphedema.png\|70px]][[File:3lymphedema.png\|70px]]
	\|-		\|-
	\| Stage III (severe)\|\|		\| Stage III (severe)\|\|

Rossdonaldson1: /* Clinical Staging (by International Society of Lymphology) International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46:1-11 */

2019-03-26T20:34:27Z

← Older revision		Revision as of 20:34, 26 March 2019
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	*NOT reversible with limb elevation alone		*NOT reversible with limb elevation alone
	*Some dermal fibrosis present		*Some dermal fibrosis present
	\|\|		\|\|[[File:2lymphedema.png\|70px]]
	\|-		\|-
	\| Stage III (severe)\|\|		\| Stage III (severe)\|\|

Rossdonaldson1: /* Clinical Staging (by International Society of Lymphology) International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46:1-11 */

2019-03-26T20:33:11Z

← Older revision		Revision as of 20:33, 26 March 2019
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	*Fluid accumulation subsides with limb elevation within 24 hours		*Fluid accumulation subsides with limb elevation within 24 hours
	*no sign of dermal fibrosis		*no sign of dermal fibrosis
	\|\|		\|\|[[File:1lymphedema.png\|70px]]
	\|-		\|-
	\| Stage II (moderate)		\| Stage II (moderate)

Rossdonaldson1: /* Clinical Staging (by International Society of Lymphology) International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46:1-11 */

2019-03-26T20:32:42Z

← Older revision		Revision as of 20:32, 26 March 2019
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	*Generally asymptomatic, although may have feeling of heaviness in limb		*Generally asymptomatic, although may have feeling of heaviness in limb
	*Swelling not evident on exam		*Swelling not evident on exam
	\|~~[[File:1lymphedema.png\|70px]]~~		\|\|
	\|
	\|-		\|-
	\| Stage I (mild)\|\|		\| Stage I (mild)\|\|

Rossdonaldson1: /* Clinical Staging (by International Society of Lymphology) International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46:1-11 */

2019-03-26T20:32:08Z

← Older revision		Revision as of 20:32, 26 March 2019
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	*Generally asymptomatic, although may have feeling of heaviness in limb		*Generally asymptomatic, although may have feeling of heaviness in limb
	*Swelling not evident on exam		*Swelling not evident on exam
	\|[[File:1lymphedema.png\|~~thumb~~]]		\|[[File:1lymphedema.png\|70px]]
	\|		\|
	\|-		\|-

Rossdonaldson1: /* Clinical Staging (by International Society of Lymphology) International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46:1-11 */

2019-03-26T20:30:08Z

← Older revision		Revision as of 20:30, 26 March 2019
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	*Generally asymptomatic, although may have feeling of heaviness in limb		*Generally asymptomatic, although may have feeling of heaviness in limb
	*Swelling not evident on exam		*Swelling not evident on exam
	\|\|		\|[[File:1lymphedema.png\|thumb]]
			\|
	\|-		\|-
	\| Stage I (mild)\|\|		\| Stage I (mild)\|\|