Sunday, February 26, 2012
Friday, February 24, 2012
An older abstract from 2002, laying the basic info foundation for understanding CT scans of leg lymphedema. Also mentioned in the article are DVTs and lipedema, and the use of the ultrasound.
High resolution unenhanced computed tomography in patients with swollen legs.
of the lower limbs: CT staging].
This is a very old abstract from 1998. What was fascinating to me personally, is the CT description of the leg tissue with lymphedema. It reminded me of the ones I have had on both legs.
Computerized tomography of 150 cases of of the
Thursday, February 16, 2012
- Grade 1 (mild edema): Lymphedema involves the distal parts such as a forearm and hand or a lower leg and foot. The difference in circumference is less than 4 centimeters, and other tissue changes are not yet present.
- Grade 2 (moderate edema): Lymphedema involves an entire limb or corresponding quadrant of the trunk. Difference in circumference is more than 4 but less than 6 centimeters. Tissue changes, such as pitting, are apparent. The patient may experience erysipelas.
- Grade 3a (severe edema): Lymphedema is present in one limb and its associated trunk quadrant. The difference in circumference is greater than 6 centimeters. Significant skin alterations, such as cornification or keratosis, cysts and/or fistulae, are present. Additionally, the patient may experience repeated attacks of erysipelas.
- Grade 3b (massive edema): The same symptoms as grade 3a, except two or moreextremities are affected.
- Grade 4 (gigantic edema): Also known as elephantiasis, in this stage of lymphedema, the affected extremities are huge due to almost complete blockage of the lymph channels. Elephantiasis may also affect the head and face.
There are three basic stages active of lymphedema. The earlier lymphedema is recognized and diagnosed, the easier it is to successful treat it and to avoid many of the complications.
It is important as well to be aware that when you have lymphedema, even in one limb there is always the possibility of another limb being affected at some later time. This “inactive” period referred to as the latency stage. It is associated with hereditary forms of lymphedema.
LATENCY STAGE or STAGE 0
Lymphatic transport capacity is reduced No visible/palpable edema Subjective complaints are possible
(Spontaneously Irreversible Lymphedema) Accumulation of protein rich edema fluid Pitting becomes progressively more difficult Connective tissue proliferation (fibrosis)
The limb is so densely fibrotic that it is not possible to make any indentation when pressed. It becomes impossible for ultrasound testing to pick even the blood pulse. The skin becomes brittle and even the slight of bumps causes a serious, extensively weeping wound. Because of the hardness of the tissue, it has become a total septic foci for bacteria and constant cellulitis and systemic infections become the norm. The only treatment for cellulitis is an extended period of IV antibiotics.
There is no treatment option for Stage Four. The complete focus is on management, containment of infections, prevention if at all possible of amputation.
Stage four information is strictly my own thinking as many do not yet recognize as Stage Four, while others have even mentioned a stage Five.
A new staging system has been set forth by Lee, Morgan and Bergan and endorsed by the American Society of Lymphology. This provides a clear technique which can be employed by clinical and laboratory assessments to more accurately diagnose and prescribe therapy for lymphedema. In this improved version, four stages are identified (I-IV). Physicians and researchers can use additional laboratory assessments, such as bioimpedance, MRI, or CT, to build on the findings of a clinical assessment (physical evaluation). From this, results of therapy can be accurately be determined and reported in documentation, as well as research.
Treatment of Leg Lymphedema