Calf local segmental lymphedema proceeds to whole limb lymphedema if not early diagnosed and treated

Introduction. Lymphedema of the lower extremities is considered to comprise the entire limb. This is most common in cases with recurrent attacks of cellulitis (dermato-lymphangio-adenitis, DLA), gradually destroying the main lymphatic collectors. However, at present, the early diagnosis and appropriate antibiotic treatment of foot or calf infection may limit the spread of microbes and the region of inflammation.

This is why we see more isolated lymphedema regions limited to the foot or part of the calf only. On the ICG imaging, confluent areas of dye at the site of inflammation with still preserved flow in the dilated collectors can be seen. Early imaging of inflammatory areas by ICG lymphography may help initiate a fast therapy.

Aim. To perform ICG lymphography in patients complaining of limited regions of edema and inflammation of any part of the lower limb so far not diagnosed as lymphedema.

Material and methods. Fifty patients showing up in OPD with circumscribed inflammatory regions of the foot or calf without edema of the limb underwent ICG lymphography, tonometry, and dielectric constant testing.

Results. Foot edema. Confluent spread of ICG in the dorsum and plantar area. Outline of the dilated collecting lymphatics in the calf and thigh. Enlarged inguinal nodes. Calf edema. Outline of dilated foot lymphatics. A confluent ICG spot embracing the lower part of the calf. Slight outline of thigh lymphatic. Enlarged inguinal nodes. Tissue stiffness at inflamed site >1.5kg/sq.cm and skin water concentration >45%.

Conclusions. Early ICG lymphography depicts areas of lymphatic involvement by the inflammatory process. Immediately employed therapy may prevent the spread of damage to collecting trunks and nodes.