3.3. Lymphatic Disorders

📄 Definition

Lymphatic disorders refer to impaired lymphatic drainage, leading to lymphoedema—a chronic, progressive swelling due to the accumulation of lymph fluid in the interstitial space.

It may be primary (congenital or idiopathic) or secondary (damage to lymphatic vessels from surgery, radiotherapy, infection, malignancy).

🧬 Classification

Primary Lymphoedema

  • Congenital (Milroy disease – presents at birth)

  • Praecox (Meige disease – adolescence onset)

  • Tarda (onset >35 years)

Secondary Lymphoedema

  • Cancer treatment – surgery or radiotherapy

  • Infection – filariasis (common in tropical regions)

  • Obesity – mechanical compression

  • Chronic venous insufficiency – venous overload impairs lymphatics

  • Trauma or recurrent cellulitis

Risk Factors – Mnemonic: SLOW FLUID

  • Surgery (lymph node dissection)

  • Lymphatic malformation (primary)

  • Obesity

  • Wounds or trauma

  • Filariasis (tropical parasitic infection)

  • Late-stage cancer

  • Ulceration or infection

  • Immobility

  • Deep vein thrombosis history

📋 Clinical Features – Mnemonic: LEGS SWELL

  • Localised swelling – usually in one or both lower limbs

  • Early pitting, becomes non-pitting over time

  • Gradual onset

  • Skin thickening – “peau d’orange” appearance

  • Stammering folds or squaring of toes (positive Stemmer’s sign)

  • Weeping (lymphorrhoea) in severe cases

  • Eczema – dry, flaky skin prone to infection

  • Lymphangitis or cellulitis risk

  • Limb heaviness or aching

Investigations

🥇 First-Line

  • Clinical examination – look for signs and distribution

  • ABPI – before applying compression therapy

  • History – rule out malignancy, DVT, or prior interventions

🥈 Second-Line (if diagnostic uncertainty)

  • Lymphoscintigraphy – maps lymphatic flow

  • MRI/CT – if malignancy or obstruction suspected

  • Ultrasound – assess soft tissue or exclude DVT

Management – Mnemonic: LEMON

  • Lifestyle – elevate limbs, moisturise, prevent trauma

  • Exercise – promotes lymphatic flow

  • Manual lymphatic drainage – by trained specialist

  • Ongoing compression therapy – multilayer bandaging or stockings (class II–III)

  • Note infections – early antibiotics for cellulitis

✅ Specialist referral if:

  • Diagnostic uncertainty

  • Sudden deterioration

  • Suspected malignancy

  • Severe disfigurement

⚠️ Complications

  • Recurrent cellulitis or lymphangitis

  • Ulceration

  • Psychosocial distress

  • Lymphangiosarcoma (rare but serious)

🔺 Last updated in line with NICE CKS – Lymphoedema

Published: January 2018 • Last updated: August 2023
Last reviewed: August 2025
✅ PASSMAP ensures all content is NICE-aligned and reviewed for Physician Associate Registration Assessment (PARA) success.

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