Primary and secondary lymphoedema in male patients with oedema in lower limbs

Abstract

Objective: The purpose of this prospective study was to evaluate patients with clinically diagnosed lymphoedema of the lower extremities. The proportions of primary and secondary lymphoedema, the possible aetiologic factors and the concomitance of chronic venous diseases and lymphoedema were focused on.

Method: The male patients who attended our outpatient clinic during 2000 and 2004 were evaluated. In all, 160 male patients with 5 cm circumference difference at calf level between two lower extremities or with clinically diagnosed bilateral leg oedema were enrolled. All patients underwent duplex venous ultrasonography and lymphoscintigraphy. Venography was performed in 12 patients with normal lymphoscintigraphy and ultrasonography.

Results: The age distribution was between 20 and 54 years (mean ± SD; 22.9 ± 4.3). Among 160 patients, 70.0% had lymphoedema, while 7.5% had chronic venous insufficiency, 3.75% chronic deep venous thrombosis, 7.5% concomitant venous disease and lymphatic obstruction, and 7.5% idiopathic oedema. In the last 3.75% the pathology was Klippel–Trenaunay syndrome. Of the primary lymphoedema patients (16.25%), 18 were praecox, six tarda and two were congenital types.

Conclusion: In young male patients, the causes of secondary lymphoedema are lymphadenectomy, neoplastic metastasis, cellulitis, lymphangitis, etc. Further techniques confirmed the clinical diagnosis of lymphoedema in 77.5% (sum of lymphoedema and concomitant disease) of all patients. With these findings lymphoedema can be diagnosed clinically, and further diagnostic techniques can be reserved unless treatment is effective.