Lymphoedema

Lymphoedema is caused by the failure of lymphatic drainage leading to accumulation of protein-rich fluid in the interstitium. The diagnosis can usually be made on history and examination alone. The most important distinction is between primary lymphoedema (which has a genetic cause) and secondary lymphoedema. Early diagnosis is essential as many conservative therapies are available and can prevent progression. In the western world lymphoedema is most commonly secondary to cancer and its treatment. In endemic regions filiariasis is an important cause and a global eradication programme is underway. Recently, progress has been made in understanding the embryology of the lymphatic system and specific genetic causes of primary lymphoedema. Surgery is reserved for advanced disease and is performed in specialist centres to reduce the bulk of swollen tissue.