Metastatic prostatic cancer in men and lymphoma in women.
What is the most common cause of neoplastic lymphedema in the lower extremities?
Metastatic prostatic cancer in men and lymphoma in women.
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How does lymphedema present? What are its causes?
Primary lymphedema is bilateral, more common in women, and with onset before 40. Secondary lymphedema is instead unilateral, equal in both sexes, and usually occurring after infections (recurrent cellulitis), radiation, surgery, or cancer. These etiologies are all at play in lymphedema of the arm, almost exclusively seen in breast cancer patients as a result of tumor, treatment (surgery/radiation), or a combination thereof. How do you grade pitting edema?
As 1+ (mild pitting, slight indentation); 2+ (moderate pitting, indentation rapidly subsiding); 3+ (deep pitting — longer indentation, leg swollen); 4+ (very deep pitting, leg very swollen). How do you elicit pitting edema?
By pressing your thumb for 1–2 seconds over the tibia, dorsum of each foot, and retromalleolar area. Pitting severity is graded from 1 to 4, with 4 being the highest. What is “pitting”?
A well-defined depression in soft tissues resulting from application of pressure—something that separates it from the “brawny” edema of hypothyroidism, inflammation, and chronic venous stasis. “Pitting” is due to accumulation of interstitial fluid and thus predominantly localized (but not necessarily so) to dependent areas, like the pre-sacrum of supine patients or the shins of standing/sitting ones. The less viscous and protein-rich the fluid, the more likely the “pitting.” What is edema of an extremity?
It is the swelling of a limb caused by accumulation of fluid. This could be serum (venous edema), lymph (lymphedema), or fat (lipedema). Are there any other causes of Charcot’s foot?
In addition to diabetes (where it affects 2% of the population), a Charcot’s foot also can occur in other peripheral neuropathies, including tertiary syphilis (which used to be the leading cause of this condition) and Charcot-Marie-Tooth disease. Which joints are most affected by Charcot’s changes?
In addition to tarsometatarsal and metatarsophalangeal joints, Charcot’s changes also can affect the ankle, causing displacement of the mortise. If neglected, calluses over pressure points will evolve into ulcerations, especially over the medial aspect of the navicular bone, the inferior aspect of the cuboid bone, and the ankle. Sinus tracts from ulcerations may then reach into the deeper planes of the foot and bone, thus leading to osteomyelitis, to which diabetics are also uniquely susceptible. Ulcers deeper than 3 mm and larger than 2 cm2 are especially predisposed to this complication.
What is Charcot’s foot?
It is a neuropathic osteoarthropathy resulting from loss of both sensation (causing unrecognized microtrauma from ill-fitting shoes) and motor control (causing intrinsic muscle weakness and splaying of the foot on weight-bearing areas, thus compounding the trauma). The result is a convex foot with a rocker-bottom appearance, where small fractures remain unnoticed until bone and joint deformities become severe. |