Edema The Ohio State University Lymphedema Center Experience Steven M Dean DO FACP RPVI Professor of Clinical Internal Medicine Division of Cardiovascular Medicine The Ohio State University ID: 810440
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Slide1
Differential Diagnosis of Limb EdemaThe Ohio State University Lymphedema Center Experience
Steven M. Dean, DO, FACP, RPVIProfessor of Clinical Internal MedicineDivision of Cardiovascular MedicineThe Ohio State University Wexner Medical Center
Slide2DisclosuresPotential Conflict: Scientific Advisory Board -
Tactile Medical
Slide3Causes of Limb Edema
OSU PT/Lymphedema clinic experience (2012-2015): n = 472Phlebolymphedema-36%Cancer/Rx (Lower extremities)-23%Mixed phlebolymphedema (CA/lipedema/primary lymphedema)-16%
Lipedema/lipo-lymphedema-10%
Primary lymphedema-8%
Other (7%)
Preliminary Data
Slide4Emedicine 2016- “In the industrialized world, the
most common causes of secondary lymphedema are
malignancy and its treatment.
”
Slide5“The most common form of lymphedema worldwide may be filarial infection but the most common in the Western world is phlebolymphedema
”Farrow. Phlebolymphedema- A Common Underdiagnosed & Undertreated Problem in the Wound Care Clinic. J Am Col CWS 2010;2: 14-23
Slide6Most common secondary cause of Lower Extremity Lymphedema
?
Phlebo-
lymphedema
Slide7Phlebolymphedema
Slide8Foot/toe swelling is NOT required to make a diagnosis of lower extremity [phlebo]lymphedema!
Slide9…
lymphatic failure is responsible for all forms of peripheral edema..
Slide10The Journal of Clinical Investigation http://
www.jci.org Volume 124 Number 3 March 2014
“All chronic edema indicates
an inadequacy or failure of lymph drainage
…”
Slide11All edema including
chronic venous insufficiency is actually lymphedema!
Slide12Slide13Feet/Toe
Sparing
Always
Bilateral
S
ymmetrical
Slide14Trunk is
spared
Slide15Lymphedema vs Lipedema
Slide16Massive Localized Lymphedema [MLL]
“Pseudotumors”“Pseudosarcomas”
Brewer 2011
Ann Plast Surg -
41 pts; average weight
421
lb [160-619]
Slide17Other “Hybrid” Limb Swelling
Slide18Lipedema with secondary lymphedema
“
Lipo
-lymphedema”
Slide19Lipedema with secondary phlebolymphededema
“
Lipo-phlebolymphedema
”
Slide20Lipedema with secondary
phlebolymphedema
“
Lipo-phlebolymphedema
”
Slide21Lipedema with foot sparing
secondary phlebolymphedema
Photo courtesy of Dr. John
aka“Jerry
” Bartholomew
“
Lipo-phlebolymphedema
”
Slide22“Lympho-lipedema”
Slide23Lipedema with secondary phlebolymphedema
“Lipo-phlebo-lymphedema
”
Slide24Phlebolymphedema, not cancer and its associated treatment, is the most common cause of secondary lower extremity lymphedema
Foot swelling is not required to make a diagnosis of phlebolymphedemaAll edema is lymphedema!Hybrid forms of limb swelling are common