Lymphoedema of the lower extremities – background, pathophysiology and diagnostic considerations
Identifieur interne : 004B40 ( Istex/Corpus ); précédent : 004B39; suivant : 004B41Lymphoedema of the lower extremities – background, pathophysiology and diagnostic considerations
Auteurs : Mads R. Jensen ; Lene Simonsen ; Tonny Karlsmark ; Jens BülowSource :
- Clinical Physiology and Functional Imaging [ 1475-0961 ] ; 2010-11.
Abstract
Lymphoedema of the lower extremities is a chronic debilitating disease that is often underdiagnosed. Early diagnosis and treatment is paramount in reducing the risk of progression and complications. Lymphoedema has traditionally been defined as interstitial oedema and protein accumulation because of a defect in the lymphatic drainage; however, some findings suggest that the interstitial protein concentration may be low in some types of lymphoedema. Primary lymphoedema is caused by an inherent defect in the lymphatic vessels or lymph nodes. Secondary lymphoedema is caused by damages to the lymphatic system most often caused by cancer or its treatment. Many of the underlying pathophysiological mechanisms have yet to be elucidated. Many methods have been developed for examination of the lymphatic system. Lymphoscintigraphy is presently the preferred diagnostic modality. Lack of consensus regarding protocol and qualitative interpretation criteria results in a too observer dependent outcome. Methods for objectifying the scintigraphy through quantification have been criticized. Depot clearance rates are an alternative method of quantification of lymphatic drainage capacity. This method however has mostly been applied on upper extremity lymphoedema. The aim of this review is to provide a literature‐based overview of the aetiology and pathophysiology of lower extremity lymphoedema and to summarize the current knowledge about lymphoscintigraphy and depot clearance techniques. The abundance of factors influencing the outcome of the examination stresses the need for consensus regarding examination protocols and interpretation. Further studies are needed to improve diagnostic performance and understanding of pathophysiological mechanisms.
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DOI: 10.1111/j.1475-097X.2010.00969.x
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Depot clearance rates are an alternative method of quantification of lymphatic drainage capacity. This method however has mostly been applied on upper extremity lymphoedema. The aim of this review is to provide a literature‐based overview of the aetiology and pathophysiology of lower extremity lymphoedema and to summarize the current knowledge about lymphoscintigraphy and depot clearance techniques. The abundance of factors influencing the outcome of the examination stresses the need for consensus regarding examination protocols and interpretation. 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Depot clearance rates are an alternative method of quantification of lymphatic drainage capacity. This method however has mostly been applied on upper extremity lymphoedema. The aim of this review is to provide a literature‐based overview of the aetiology and pathophysiology of lower extremity lymphoedema and to summarize the current knowledge about lymphoscintigraphy and depot clearance techniques. The abundance of factors influencing the outcome of the examination stresses the need for consensus regarding examination protocols and interpretation. 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Early diagnosis and treatment is paramount in reducing the risk of progression and complications. Lymphoedema has traditionally been defined as interstitial oedema and protein accumulation because of a defect in the lymphatic drainage; however, some findings suggest that the interstitial protein concentration may be low in some types of lymphoedema. Primary lymphoedema is caused by an inherent defect in the lymphatic vessels or lymph nodes. Secondary lymphoedema is caused by damages to the lymphatic system most often caused by cancer or its treatment. Many of the underlying pathophysiological mechanisms have yet to be elucidated. Many methods have been developed for examination of the lymphatic system. Lymphoscintigraphy is presently the preferred diagnostic modality. Lack of consensus regarding protocol and qualitative interpretation criteria results in a too observer dependent outcome. Methods for objectifying the scintigraphy through quantification have been criticized. Depot clearance rates are an alternative method of quantification of lymphatic drainage capacity. This method however has mostly been applied on upper extremity lymphoedema. The aim of this review is to provide a literature‐based overview of the aetiology and pathophysiology of lower extremity lymphoedema and to summarize the current knowledge about lymphoscintigraphy and depot clearance techniques. The abundance of factors influencing the outcome of the examination stresses the need for consensus regarding examination protocols and interpretation. Further studies are needed to improve diagnostic performance and understanding of pathophysiological mechanisms.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="k1">aetiology</term><term xml:id="k2">chronic oedema</term><term xml:id="k3">interstitial fluid regulation</term><term xml:id="k4">lymphoscintigraphy</term><term xml:id="k5">physiology of the lymphatic system</term><term xml:id="k6">removal rate constant</term></keywords><classCode scheme="tocHeading1">Review Articles</classCode></textClass><langUsage><language ident="EN"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/A039E56F0658B2455EA19FF1D9C08040508CBA10/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1475-097X</doi><issn type="print">1475-0961</issn><issn type="electronic">1475-097X</issn><idGroup><id type="product" value="CPF"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="CLINICAL PHYSIOLOGY FUNCTIONAL IMAGING">Clinical Physiology and Functional Imaging</title></titleGroup></publicationMeta><publicationMeta level="part" position="11106"><doi origin="wiley">10.1111/cpf.2010.30.issue-6</doi><numberingGroup><numbering type="journalVolume" number="30">30</numbering><numbering type="journalIssue" number="6">6</numbering></numberingGroup><coverDate startDate="2010-11">November 2010</coverDate></publicationMeta><publicationMeta level="unit" type="reviewArticle" position="2" status="forIssue"><doi origin="wiley">10.1111/j.1475-097X.2010.00969.x</doi><idGroup><id type="unit" value="CPF969"></id></idGroup><countGroup><count type="pageTotal" number="10"></count></countGroup><titleGroup><title type="tocHeading1">Review Articles</title></titleGroup><copyright>© 2010 The Authors. Clinical Physiology and Functional Imaging © 2010 Scandinavian Society of Clinical Physiology and Nuclear Medicine</copyright><eventGroup><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.22 mode:FullText" date="2010-10-08"></event><event type="publishedOnlineEarlyUnpaginated" date="2010-08-16"></event><event type="firstOnline" date="2010-08-16"></event><event type="publishedOnlineFinalForm" date="2010-10-08"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-16"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-17"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="389">389</numbering><numbering type="pageLast" number="398">398</numbering></numberingGroup><correspondenceTo>Mads Radmer Jensen, Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University Hospital of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
E‐mail: <email>mjen0221@bbh.regionh.dk</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:CPF.CPF969.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory><b>Accepted for publication</b> <i>Received 22 May 2010;</i> <i>accepted 26 July 2010</i></unparsedEditorialHistory><countGroup><count type="figureTotal" number="0"></count><count type="tableTotal" number="0"></count></countGroup><titleGroup><title type="main">Lymphoedema of the lower extremities – background, pathophysiology and diagnostic considerations</title><title type="shortAuthors">M. R. Jensen et al.</title><title type="short">Lymphoedema of the Lower Extremities</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>Mads R.</givenNames><familyName>Jensen</familyName></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a1"><personName><givenNames>Lene</givenNames><familyName>Simonsen</familyName></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a2"><personName><givenNames>Tonny</givenNames><familyName>Karlsmark</familyName></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a1"><personName><givenNames>Jens</givenNames><familyName>Bülow</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="a1" countryCode="DK"><unparsedAffiliation>Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University Hospital of Copenhagen, Copenhagen NV, Denmark</unparsedAffiliation></affiliation><affiliation xml:id="a2" countryCode="DK"><unparsedAffiliation>Department of Dermatology and Venerology, Bispebjerg Hospital, University Hospital of Copenhagen, Copenhagen NV, Denmark</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">aetiology</keyword><keyword xml:id="k2">chronic oedema</keyword><keyword xml:id="k3">interstitial fluid regulation</keyword><keyword xml:id="k4">lymphoscintigraphy</keyword><keyword xml:id="k5">physiology of the lymphatic system</keyword><keyword xml:id="k6">removal rate constant</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Summary</title><p>Lymphoedema of the lower extremities is a chronic debilitating disease that is often underdiagnosed. Early diagnosis and treatment is paramount in reducing the risk of progression and complications. Lymphoedema has traditionally been defined as interstitial oedema and protein accumulation because of a defect in the lymphatic drainage; however, some findings suggest that the interstitial protein concentration may be low in some types of lymphoedema. Primary lymphoedema is caused by an inherent defect in the lymphatic vessels or lymph nodes. Secondary lymphoedema is caused by damages to the lymphatic system most often caused by cancer or its treatment. Many of the underlying pathophysiological mechanisms have yet to be elucidated. Many methods have been developed for examination of the lymphatic system. Lymphoscintigraphy is presently the preferred diagnostic modality. Lack of consensus regarding protocol and qualitative interpretation criteria results in a too observer dependent outcome. Methods for objectifying the scintigraphy through quantification have been criticized. Depot clearance rates are an alternative method of quantification of lymphatic drainage capacity. This method however has mostly been applied on upper extremity lymphoedema. The aim of this review is to provide a literature‐based overview of the aetiology and pathophysiology of lower extremity lymphoedema and to summarize the current knowledge about lymphoscintigraphy and depot clearance techniques. The abundance of factors influencing the outcome of the examination stresses the need for consensus regarding examination protocols and interpretation. Further studies are needed to improve diagnostic performance and understanding of pathophysiological mechanisms.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Lymphoedema of the lower extremities – background, pathophysiology and diagnostic considerations</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Lymphoedema of the Lower Extremities</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Lymphoedema of the lower extremities – background, pathophysiology and diagnostic considerations</title></titleInfo><name type="personal"><namePart type="given">Mads R.</namePart><namePart type="family">Jensen</namePart><affiliation>Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University Hospital of Copenhagen, Copenhagen NV, Denmark</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lene</namePart><namePart type="family">Simonsen</namePart><affiliation>Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University Hospital of Copenhagen, Copenhagen NV, Denmark</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Tonny</namePart><namePart type="family">Karlsmark</namePart><affiliation>Department of Dermatology and Venerology, Bispebjerg Hospital, University Hospital of Copenhagen, Copenhagen NV, Denmark</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jens</namePart><namePart type="family">Bülow</namePart><affiliation>Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University Hospital of Copenhagen, Copenhagen NV, Denmark</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="review-article" displayLabel="reviewArticle"></genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2010-11</dateIssued><edition>Accepted for publication Received 22 May 2010; accepted 26 July 2010</edition><copyrightDate encoding="w3cdtf">2010</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Lymphoedema of the lower extremities is a chronic debilitating disease that is often underdiagnosed. Early diagnosis and treatment is paramount in reducing the risk of progression and complications. Lymphoedema has traditionally been defined as interstitial oedema and protein accumulation because of a defect in the lymphatic drainage; however, some findings suggest that the interstitial protein concentration may be low in some types of lymphoedema. Primary lymphoedema is caused by an inherent defect in the lymphatic vessels or lymph nodes. Secondary lymphoedema is caused by damages to the lymphatic system most often caused by cancer or its treatment. Many of the underlying pathophysiological mechanisms have yet to be elucidated. Many methods have been developed for examination of the lymphatic system. Lymphoscintigraphy is presently the preferred diagnostic modality. Lack of consensus regarding protocol and qualitative interpretation criteria results in a too observer dependent outcome. Methods for objectifying the scintigraphy through quantification have been criticized. Depot clearance rates are an alternative method of quantification of lymphatic drainage capacity. This method however has mostly been applied on upper extremity lymphoedema. The aim of this review is to provide a literature‐based overview of the aetiology and pathophysiology of lower extremity lymphoedema and to summarize the current knowledge about lymphoscintigraphy and depot clearance techniques. The abundance of factors influencing the outcome of the examination stresses the need for consensus regarding examination protocols and interpretation. Further studies are needed to improve diagnostic performance and understanding of pathophysiological mechanisms.</abstract><subject lang="en"><genre>keywords</genre><topic>aetiology</topic><topic>chronic oedema</topic><topic>interstitial fluid regulation</topic><topic>lymphoscintigraphy</topic><topic>physiology of the lymphatic system</topic><topic>removal rate constant</topic></subject><relatedItem type="host"><titleInfo><title>Clinical Physiology and Functional Imaging</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1475-0961</identifier><identifier type="eISSN">1475-097X</identifier><identifier type="DOI">10.1111/(ISSN)1475-097X</identifier><identifier type="PublisherID">CPF</identifier><part><date>2010</date><detail type="volume"><caption>vol.</caption><number>30</number></detail><detail type="issue"><caption>no.</caption><number>6</number></detail><extent unit="pages"><start>389</start><end>398</end><total>10</total></extent></part></relatedItem><identifier type="istex">A039E56F0658B2455EA19FF1D9C08040508CBA10</identifier><identifier type="DOI">10.1111/j.1475-097X.2010.00969.x</identifier><identifier type="ArticleID">CPF969</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2010 The Authors. Clinical Physiology and Functional Imaging © 2010 Scandinavian Society of Clinical Physiology and Nuclear Medicine</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Publishing Ltd</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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