Limits...
Obesity-induced Lymphedema Nonreversible following Massive Weight Loss.

Greene AK, Grant FD, Maclellan RA - Plast Reconstr Surg Glob Open (2015)

Bottom Line: We report our first patient with obesity-induced lower extremity lymphedema who was followed prospectively before and after weight loss.After reaching her new steady-state BMI of 36 eighteen months following her procedure, lymphoscintigraphy showed no improvement in lower extremity lymphatic function.Unlike other comorbidities that reverse following massive weight loss, obesity-induced lymphedema may not resolve.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Oral Surgery, Lymphedema Program, Boston Children's Hospital, Harvard Medical School, Boston, Mass.; and Division of Nuclear Medicine, Department of Radiology, Lymphedema Program, Boston Children's Hospital, Harvard Medical School, Boston, Mass.

ABSTRACT
Lymphedema is the progressive enlargement of tissue due to inadequate lymphatic function. Obesity-induced lymphedema of the lower extremities can occur once a patient's body mass index (BMI) exceeds 50. We report our first patient with obesity-induced lower extremity lymphedema who was followed prospectively before and after weight loss. A 46-year-old woman with a BMI of 80 presented to our Lymphedema Program complaining of bilateral lower extremity swelling. Lymphoscintigraphy showed impaired lymphatic drainage of both lower extremities consistent with lymphedema. She was referred to a bariatric surgical weight-loss center and underwent a sleeve gastrectomy. After reaching her new steady-state BMI of 36 eighteen months following her procedure, lymphoscintigraphy showed no improvement in lower extremity lymphatic function. Patients at risk for obesity-induced lymphedema should be counseled that they should seek weight-loss interventions before their BMI reaches 50, a threshold at which point lower extremity lymphedema may occur. Unlike other comorbidities that reverse following massive weight loss, obesity-induced lymphedema may not resolve.

No MeSH data available.


Related in: MedlinePlus

Obesity-induced lymphedema not improved following massive weight loss. A, Forty-six-year-old woman with a BMI of 71 before undergoing a weight-loss operation. Lymphoscintigram shows delayed transit of Tc-99m filtered sulfur colloid to the inguinal nodes 45 minutes following intradermal injection into the feet consistent with lymphatic dysfunction and lymphedema (*). Lymph nodes are visualized 2 hours following administration of radiolabeled tracer (^). B, Eighteen months following sleeve gastrectomy the patient’s BMI decreased to 36. Lymphoscintigram image of inguinal nodes at 45 minutes (*) and 120 minutes (^). Despite significant reduction in the size of her lower extremities, she continues to have delayed transit of radiolabeled tracer to her inguinal nodes and no improvement in her lymphatic function.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4494496&req=5

Figure 1: Obesity-induced lymphedema not improved following massive weight loss. A, Forty-six-year-old woman with a BMI of 71 before undergoing a weight-loss operation. Lymphoscintigram shows delayed transit of Tc-99m filtered sulfur colloid to the inguinal nodes 45 minutes following intradermal injection into the feet consistent with lymphatic dysfunction and lymphedema (*). Lymph nodes are visualized 2 hours following administration of radiolabeled tracer (^). B, Eighteen months following sleeve gastrectomy the patient’s BMI decreased to 36. Lymphoscintigram image of inguinal nodes at 45 minutes (*) and 120 minutes (^). Despite significant reduction in the size of her lower extremities, she continues to have delayed transit of radiolabeled tracer to her inguinal nodes and no improvement in her lymphatic function.

Mentions: A 46-year-old woman presented to our Lymphedema Program complaining of bilateral lower extremity swelling. Her height and weight were 153 cm and 187 kg (BMI = 80). The patient reported that at age 34 she weighed 68 kg (BMI = 29), her legs were asymptomatic, and she subsequently began to steadily gain weight. Other than her obesity, she had no risk factors for lymphedema (eg, family history of lymphedema, primary lymphedema, travel to areas endemic for filariasis, and inguinal radiation/lymphadenectomy/operations). The patient’s lower extremity lymphatic function was evaluated by lymphoscintigraphy, which is 100% specific and 92% sensitive for lymphedema.3 Lymphoscintigraphy at her initial presentation showed impaired lymphatic drainage of both lower extremities consistent with lymphedema (Fig. 1). She was referred to a bariatric surgical weight-loss center and underwent a sleeve gastrectomy. After reaching her new steady-state BMI of 36 eighteen months following her procedure, lymphoscintigraphy showed no improvement in lower extremity lymphatic function.


Obesity-induced Lymphedema Nonreversible following Massive Weight Loss.

Greene AK, Grant FD, Maclellan RA - Plast Reconstr Surg Glob Open (2015)

Obesity-induced lymphedema not improved following massive weight loss. A, Forty-six-year-old woman with a BMI of 71 before undergoing a weight-loss operation. Lymphoscintigram shows delayed transit of Tc-99m filtered sulfur colloid to the inguinal nodes 45 minutes following intradermal injection into the feet consistent with lymphatic dysfunction and lymphedema (*). Lymph nodes are visualized 2 hours following administration of radiolabeled tracer (^). B, Eighteen months following sleeve gastrectomy the patient’s BMI decreased to 36. Lymphoscintigram image of inguinal nodes at 45 minutes (*) and 120 minutes (^). Despite significant reduction in the size of her lower extremities, she continues to have delayed transit of radiolabeled tracer to her inguinal nodes and no improvement in her lymphatic function.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4494496&req=5

Figure 1: Obesity-induced lymphedema not improved following massive weight loss. A, Forty-six-year-old woman with a BMI of 71 before undergoing a weight-loss operation. Lymphoscintigram shows delayed transit of Tc-99m filtered sulfur colloid to the inguinal nodes 45 minutes following intradermal injection into the feet consistent with lymphatic dysfunction and lymphedema (*). Lymph nodes are visualized 2 hours following administration of radiolabeled tracer (^). B, Eighteen months following sleeve gastrectomy the patient’s BMI decreased to 36. Lymphoscintigram image of inguinal nodes at 45 minutes (*) and 120 minutes (^). Despite significant reduction in the size of her lower extremities, she continues to have delayed transit of radiolabeled tracer to her inguinal nodes and no improvement in her lymphatic function.
Mentions: A 46-year-old woman presented to our Lymphedema Program complaining of bilateral lower extremity swelling. Her height and weight were 153 cm and 187 kg (BMI = 80). The patient reported that at age 34 she weighed 68 kg (BMI = 29), her legs were asymptomatic, and she subsequently began to steadily gain weight. Other than her obesity, she had no risk factors for lymphedema (eg, family history of lymphedema, primary lymphedema, travel to areas endemic for filariasis, and inguinal radiation/lymphadenectomy/operations). The patient’s lower extremity lymphatic function was evaluated by lymphoscintigraphy, which is 100% specific and 92% sensitive for lymphedema.3 Lymphoscintigraphy at her initial presentation showed impaired lymphatic drainage of both lower extremities consistent with lymphedema (Fig. 1). She was referred to a bariatric surgical weight-loss center and underwent a sleeve gastrectomy. After reaching her new steady-state BMI of 36 eighteen months following her procedure, lymphoscintigraphy showed no improvement in lower extremity lymphatic function.

Bottom Line: We report our first patient with obesity-induced lower extremity lymphedema who was followed prospectively before and after weight loss.After reaching her new steady-state BMI of 36 eighteen months following her procedure, lymphoscintigraphy showed no improvement in lower extremity lymphatic function.Unlike other comorbidities that reverse following massive weight loss, obesity-induced lymphedema may not resolve.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Oral Surgery, Lymphedema Program, Boston Children's Hospital, Harvard Medical School, Boston, Mass.; and Division of Nuclear Medicine, Department of Radiology, Lymphedema Program, Boston Children's Hospital, Harvard Medical School, Boston, Mass.

ABSTRACT
Lymphedema is the progressive enlargement of tissue due to inadequate lymphatic function. Obesity-induced lymphedema of the lower extremities can occur once a patient's body mass index (BMI) exceeds 50. We report our first patient with obesity-induced lower extremity lymphedema who was followed prospectively before and after weight loss. A 46-year-old woman with a BMI of 80 presented to our Lymphedema Program complaining of bilateral lower extremity swelling. Lymphoscintigraphy showed impaired lymphatic drainage of both lower extremities consistent with lymphedema. She was referred to a bariatric surgical weight-loss center and underwent a sleeve gastrectomy. After reaching her new steady-state BMI of 36 eighteen months following her procedure, lymphoscintigraphy showed no improvement in lower extremity lymphatic function. Patients at risk for obesity-induced lymphedema should be counseled that they should seek weight-loss interventions before their BMI reaches 50, a threshold at which point lower extremity lymphedema may occur. Unlike other comorbidities that reverse following massive weight loss, obesity-induced lymphedema may not resolve.

No MeSH data available.


Related in: MedlinePlus