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Lymphedema 602.e3

ultrasonography to identify venous obstruc- Possible Complications Client Education
tion or AV fistula Recurrent infection in normal limbs is likely, • Observe the swelling for discharge, odor, or
VetBooks.ir • Serologic tests or polymerase chain reaction Recommended Monitoring • Constitutional signs (anorexia, lethargy, fever) Diseases and Disorders
inability to use a limb.
even in cases of resolved primary lymphedema.
• Culture and sensitivity (in cases of
lymphangitis)
should prompt re-evaluation.
(PCR) for tick-borne infections, including
Bartonella spp • Limb size, firmness, and associated pain SUGGESTED READING
• Use of affected limbs
• Fluid and serum triglyceride concentrations • Changes in subcutaneous swellings Scansen BA, et al: Venous and lymphatic diseases. In
when there is pleural or peritoneal effusion; Ettinger SJ, et al, editors: Textbook of veterinary
elevated fluid: serum triglycerides suggest a PROGNOSIS & OUTCOME internal medicine, ed 8, St. Louis, 2017, Elsevier,
diagnosis of chylous effusion. pp 1349-1362.
• CT, including angiography or lymphangiog- • Spontaneous resolution or marked
raphy, can identify mass lesions and highlight improvement in some dogs with primary ADDITIONAL SUGGESTED
vascular or lymphatic structures to clarify lymphedema READINGS
vessel structure/patency. • Death or euthanasia related to complications Curran KM, et al: Lymphangiosarcoma in 12 dogs:
• Lymphoscintigraphy or lymphangiography: of lymphedema a case series (1998-2013). Vet Comp Oncol
these advanced radiologic methods may • Spontaneous death of puppies with general- 14:181-190, 2016.
demonstrate normal or abnormal lymphatic ized anasarca Davies AP, et al: Primary lymphedema in three dogs.
drainage. The patent blue-violet dye test has J Am Vet Med Assoc 174:1316-1320, 1979.
been used to diagnose congenital lymph- PEARLS & CONSIDERATIONS Fossum TW, et al: Lymphedema: clinical signs,
edema in dogs and cats. diagnosis, and treatment. J Vet Intern Med
6:312-319, 1992.
Comments Fossum TW, et al: Lymphedema: etiopathogenesis.
TREATMENT • In primary lymphedema, the swelling is J Vet Intern Med 6:283-293, 1992.
typically caudal and bilateral; regional Jacobsen JO, et al: Primary lymphoedema in a kitten.
Treatment Overview lymph nodes are smaller or absent (whereas J Small Anim Pract 38:18-20, 1997.
• Correct the underlying disorder if possible in healthy puppies, superficial lymph nodes Kang JH, et al: Secondary malignant lymphoedema
(e.g., treat a malignancy with chemotherapy). are prominent). after mastectomy in two dogs. J Small Anim Pract
• Prevent or treat infections. • A subtle pleural effusion in a dog with 48:579-583, 2007.
• Protect swollen tissues from injury; consider limb edema is suggestive of a more Leighton RL, et al: Primary lymphedema of the
lightly compressive bandages. generalized lymphatic disorder (or severe hindlimb in the dog. J Am Vet Med Assoc
175:369-374, 1979.
• Improve macrophage function to reduce hypoalbuminemia). Lenard ZM, et al: Lymphangiosarcoma in two cats.
protein-rich edema. • Lymphangioma and lymphangiosarcoma can J Feline Med Surg 9:161-167, 2007.
• Treat associated pain. result in severe lymphedema unresponsive Schuller S, et al: Idiopathic chylothorax and
to treatment; biopsy is usually needed for lymphedema in 2 whippet littermates. Can Vet J
Acute General Treatment definitive diagnosis. 52:1243-1245, 2011.
• Antimicrobial treatment of infections • When pelvic limb edema is caused by right Williams JH: Lymphangiosarcoma of dogs: a review.
• Pain management for tense lymphedema or heart failure, expect ascites to be present. J S Afr Vet Assoc 76:127-131, 2005.
infection • Consultation with a radiologist can be
informative regarding advanced imaging RELATED CLIENT EDUCATION
Chronic Treatment methods. SHEET
• Soft compression bandages (may not be well
tolerated; discontinue if uncomfortable) Technician Tips How to Perform Range-of-Motion Exercises
• Controlled exercise or physical therapy to Evaluate edematous patients for increased
enhance venous return respiratory rate or effort and evidence of AUTHORS: John D. Bonagura, DVM, MS, DACVIM;
• Long-term use of benzopyrones, such as rutin distress. When in doubt, provide oxygen, and Brian A. Scansen, DVM, MS, DACVIM
EDITOR: Meg M. Sleeper, VMD, DACVIM
50 mg/kg PO q 8h, to enhance macrophage seek immediate assistance.
function and proteolysis (limited proof of
efficacy)
• Advanced surgical techniques are of uncertain
value: consult with a surgical specialist.

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