Lymphoedema

Lymphoedema: chronic swelling from impaired lymphatic drainage. Primary (rare, genetic): Milroy disease (congenital), Meige disease (peri-pubertal), Lymphoedema tarda (>35y). Secondary (common): • Cancer-related: breast cancer (axillary lymph node clearance + radiotherapy), gynaecological, urological. • Filariasis (tropical). • Recurrent cellulitis (creates fibrosis). • Surgery / trauma. • Chronic venous insufficiency. • Obesity-related lymphoedema. Features: persistent unilateral or bilateral limb swelling, pitting initially → non-pitting fibrotic later, Stemmer sign positive (cannot pinch skin at base of 2nd toe), papillomatosis, skin changes (peau d'orange). Distinguish: • DVT (acute, painful, unilateral) — Doppler USS. • Heart failure / hypoalbuminaemia (bilateral, pitting). • Lipoedema (bilateral, fatty distribution, Stemmer negative). • Filariasis if travel history.