Introduction
Primary lymphedema is generally classified into congenital, praecox and tarda by onset age. In particular, primary lymphedema occur frequently in the lower limb, and unilateral arm swelling is rarely reported. In this report, we present a patient with lymphedema tarda of the unilateral upper limb.
Case report
An 89-year-old female was referred to the Department of Rehabilitation for the evaluation of progressive left arm swelling for 3 months. She has no history of trauma, surgery and cancer treatment. On physical examination, firm pitting edema was palpated on left whole arm including hand dorsum. Difference of circumference was 5.5cm at upper arm and 6.6cm at forearm. There was no abnormalities in the right arm and legs. Laboratory investigations were performed, and complete blood counts, electrolytes, creatinine, D-dimer and acute phase reactants were within normal limits. Contrast-enhanced computed tomography scans of the chest and abdomen did not show specific findings. RI lymphoscintigraphy showed the lymphatic flow of the left upper limb was slower than that of the right upper limb. The left axillary lymph nodes were observed late and activity was lower than right. A dermal backflow was also observed in the left forearm. To exclude the hidden malignancy such as breast cancer, she was referred to the Department of Breast Surgery. Breast ultrasonography revealed no specific findings except for a left axillary lymph node enlargement. Fine Needle Aspiration(FNA) biopsy was performed for that lymph node, and results showed numerous polymorphous lymphoid cells consistent with a reactive lymph node. Finally, she was diagnosed as lymphedema tarda occurred in unilateral upper limb, and managed with compressive garment and flavonoid.
Conclusion
Primary lymphedema isolated on unilateral upper limb is a rare presentation of lymphedema. In this case, we could diagnose the lymphedema tarda after exclude secondary causes by laboratory and imaging studies.
|
