Obesity-Induced Lymphedema

Normal lymphoscintigram

Abnormal lymphoscintigram

Female

Male

Age

Body mass index (mean)

<0.0001

Diabetes

0.1

Heart failure

Hypercholesterolemia

0.15

Hypertension

0.16

Venous insufficiency

0.51

With permission from Greene AK, Grant F, Slavin SA, Maclellan RA. Obesity-induced lymphedema: clinical and lymphoscintigraphic features. Plast Reconstr Surg (in press)

Two cohorts of patients with obesity-induced lymphedema exist: (1) individuals who do not have a history of significant weight loss and are at their maximum BMI at the time of the lymphoscintigram (Table 9.2) and (2) subjects with a history of massive weight loss following a bariatric surgical procedure or dieting and are not at their maximum BMI at the time of lymphoscintigram (Table 9.3). Patients without a history of weight loss who have lymphedema have a greater BMI [72.9 (range, 54.1–83.3)] compared to individuals without lymphedema [37.7 (range, 30.3–55.8)] (p < 0.0001) [6]. In these patients a BMI threshold between 50 and 60 exists at which point lymphatic dysfunction occurs. All subjects with a BMI <50 had normal lymphatic function and every person with a BMI >60 had lymphatic dysfunction. Individuals with a BMI between 50 and 60 had either normal or abnormal lymphatic function (Fig. 9.1) [6].

Table 9.2

Cohort of obese patients at their maximum BMI at time of lymphoscintigraphy (n = 33)

	Normal lymphoscintigram	Abnormal lymphoscintigram	p
n	22	11
Female	19	6
Male	3	5
Age	53.3 years (range, 14–86)	55.0 years (range, 30–73)
Body mass index	37.7 (range, 30.0–55.8)	72.0 (range, 54.1–83.3)	<0.0001

With permission from Greene AK, Grant F, Slavin SA, Maclellan RA. Obesity-induced lymphedema: clinical and lymphoscintigraphic features. Plast Reconstr Surg (in press)

Table 9.3

Cohort of obese patients with a history of weight loss and not at their maximum BMI at time of lymphoscintigraphy (n = 18)

	Normal lymphoscintigram	Abnormal lymphoscintigram	p
n	9	9
Female	7	6
Male	2	3
Age	54.0 years (range, 34–63)	54.0 years (range, 35–71)
Maximum body mass index	63.1 (range, 44.3–85.4)	78.6 (range, 60.4–105.6)	0.03
Current body mass index	41.6 (range, 30.0–53.1)	56.1 (range, 43.9–73.3)	0.005
Body mass index change	20.1 (range, 5.3–36.2)	22.5 (range, 4.4–45.2)	0.7

With permission from Greene AK, Grant F, Slavin SA, Maclellan RA. Obesity-induced lymphedema: clinical and lymphoscintigraphic features. Plast Reconstr Surg (in press)

Fig. 9.1

Increasing BMI causes lower extremity lymphatic dysfunction. Patients without a history of massive weight loss and a BMI <50 have normal lower extremity lymphatic function. Individuals with a BMI >60 have abnormal findings on lymphoscintigraphy consistent with lymphedema. A BMI threshold exists between 50 and 60 at which point lymphatic dysfunction occurs. Patients on the left with a normal lymphoscintigram exhibit inguinal lymph node uptake of technetium Tc-99m sulfur colloid 45 min after injection into the feet. Subjects on the right with an abnormal lymphoscintigram illustrate delayed transport of tracer and/or dermal backflow on 3 h images. Black arrows identify inguinal lymph nodes, and the white arrow marks dermal backflow. With permission from Greene AK, Grant F, Slavin SA, Maclellan RA. Obesity-induced lymphedema: clinical and lymphoscintigraphic features. Plast Reconstr Surg (in press)

Patients who have lost significant weight prior to their lymphoscintigram have more variable findings compared to the homogenous group without a history of weight loss. Individuals who have lost weight and have abnormal lymphoscintigraphy findings have a greater historical BMI (78.6; p

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