Pitting edema #2


I think the previous post was missed…..or nothing to add?




I think the previous post was missed…..or nothing to add?



6 responses to “Pitting edema #2”

  1. Article from VIN Associate

    Article from VIN Associate for your information.

    Often not an easy problem to determine. I would for sure aspirate the leg and the LN.

    I hope there is something in here that helps you.


    Last updated on 2/6/2015.

    Revised by Kari Rothrock DVM, 2/6/2015
    Original author was Linda G. Shell DVM, DACVIM (Neurology), 2/16/2004

    Disease description:
    Lymphedema is the abnormal accumulation of protein-rich lymph fluid in the interstitial space. Lymphedema may be primary or secondary.1 Primary lymphedema occurs with developmental abnormalities of the lymphatic system. Secondary lymphedema arises from acquired disorders that result in abnormalities of the lymphatic system.2

    Etiology and Pathophysiology
    Lymphedema occurs when capillary filtration exceeds the resorptive capabilities of the venous and lymphatic system. This imbalance can be caused by overload of the lymphatic system; inadequate collection by the lymphatic terminal buds; abnormal lymphatic contractility; insufficient numbers of lymphatics; lymph node obstruction; and thoracic duct problems.3 In cases of primary lymphedema, aplasia or hypoplasia of the lymphatic vessels and valves; lymph node fibrosis; or decreased lymph node size and number can be present.2 As edema progresses, the resulting high osmotic pressure pulls additional fluid into the interstitial space and worsens the edema. Collagen deposition and fibrosis occur with chronic lymphedema.3

    Primary lymphedema may be idiopathic or hereditary. Secondary lymphedema can occur due to disorders that cause altered vascular permeability; damage or obstruction to the lymphatic vessels or nodes; or venous hypertension.1 Lymphoproliferative disorders, neoplasia, filariasis, trauma, surgery, radiation therapy, congestive heart failure, heat exposure, and infection have all been associated with secondary lymphedema.1,3

    Physical Examination Findings: Peripheral edema is the most common clinical sign associated with lymphedema. Edema is most common in the extremities (especially the hind limbs) and may be unilateral or bilateral.4 Less commonly, the ventral thorax, abdomen, ears, and tail may be involved. Initially the edema is pitting and nonpainful. Pitting is lost as fibrosis develops over time. Pain and lameness are not seen with lymphedema unless massive enlargement of the limb or cellulitis develop.4 In cases of congenital lymphedema, clinical signs are present at birth or develop several months later.1 Peripheral lymph nodes may be small on palpation. Edematous areas are at increased risk for ulceration, drainage, trauma, and infection.2

    Complete Blood Count (CBC)/Biochemistry Panel: CBC and chemistry panels are usually normal. Affected patients are not hypoalbuminemic.3

    Fine Needle Aspirate and Cytology: Aspirates of edematous areas yield a low-cellular transudate.2 The fluid is usually protein rich (2-5 g/dL).3 Increased numbers of leukocytes may be seen with secondary infection or inflammation.3

    Lymphangiography: Radiographic lymphangiography can show lymph node aplasia and lymphatic vessels that end blindly in cases of primary lymphedema. In secondary lymphedema lymphatics may be enlarged and tortuous, and lymph nodes may be enlarged, with filling defects.2

    Histopathology: Histology can be used to rule out other causes of edema and to detect morphological abnormalities of the lymphatic system that are consistent with lymphedema.2


    Disease description in this species:
    Lymphedema can be primary or secondary and is more common in dogs than in cats. Congenital, hereditary lymphedema has been reported in English bulldogs and poodles.1,2 A possible breed predilection is reported for the Labrador retriever and Old English sheepdogs.1 No sex predisposition has been documented.

    Clinical Signs
    Nonpainful, pitting peripheral edema is the classic sign of lymphedema. The hind limbs are most commonly affected. As edema becomes chronic, pitting no longer is present. Lameness and pain are typically absent unless marked enlargement of the limb or cellulitis occur.3,4 Other clinical sings may be present depending on the underlying disease that is causing secondary lymphedema.


    Congenital anomalies
    Genetic, hereditary
    Heart failure, right-sided
    Idiopathic, unknown
    Lymphatic obstruction
    Lymphatic rupture
    Surgical complication

    Breed predilection:
    English bulldog
    Labrador retriever
    Old English sheepdog

    Sex predilection:

    Age predilection:
    Young adult

    Diagnostic procedures:     Diagnostic results:
    Biopsy and histopathology of lymph node/lymphatics   Low cellularity transudate, lymph node
        Lymphatics dilated
        Lymphoid depletion
    Radiography, contrast procedure   Aplastic lymphatics, lymph nodes
        Lymphatics end blindly
        Lymphatics enlarged, tortuous



    Click on each image to see a larger view

    Figure 1A. Pitting edema in limbs
    Figure 1A. Pitting edema in limbs

    This 5-month-old puppy had edema in three limbs since adoption. The edema had not worsened. A presumptive diagnosis of congenital primary lymphedema was made.


    Figure 1B. Same puppy as in Figure 1A
    Figure 1B. Same puppy as in Figure 1A


    Figure 2A. Congenital lymph edema of hindlimb
    Figure 2A. Congenital lymph edema of hindlimb

    Click here to see board discussion


    Figure 2B. Congenital lymph edema of hindlimb
    Figure 2B. Congenital lymph edema of hindlimb

    Same puppy as in Figure 2A.


    Figure 3. Congenital lymphedema
    Figure 3. Congenital lymphedema

    Click here to see board discussion

    Recommended therapy depends on severity of the disease. No therapy may be required for mild cases.2 Pressure bandages or splints can be applied to limit fluid accumulation and encourage lymphatic flow.1,2

    Benzopyrones, such as rutin and coumarin, have been used to treat experimental lymphedema in dogs.15,16 Rutin reduces high-protein edema by stimulating macrophages to release proteases.1 Doses of 50-100 mg/kg PO q 8 hrs have been suggested.1,3

    Surgical therapy has been used when conservative management fails but no surgical procedures are consistently beneficial. Lymphangioplasty, lymphaticovenous shunting, and lymphatic anastomosis have all been performed for lymphedema.1,10 Amputation is a viable alternative for unilateral lymphedema.3

    Corticosteroids, fibrinolytic agents, and anticoagulants have been tried for lymphedema but have shown no real benefit. Diuretics are contraindicated since they increase protein content of interstitial fluid and can result in further fibrosis.1,4 Topical skin care helps to prevent secondary complications, such as infection and ulceration. Antibiotic therapy is indicated if secondary infection is present.2

    Any underlying disorder causing secondary lymphedema should be identified and treated appropriately.

    Lymphedema itself is not typically life-threatening. Puppies with severe, generalized lymphedema can die within the first few weeks of life, however. Prognosis for survival improves if an affected patient survives the neonatal period.2 Some cases of lymphedema can spontaneously regress but edema does not typically resolve in affected dogs.1 Lymphangiosarcoma has been associated with primary lymphedema in a few humans and one dog, but neoplasia in conjunction with primary lymphedema is rare in dogs.4


    Preventive Measures:
    Affected animals should not be bred due to the potential inheritable nature of primary lymphedema.4


    Special considerations:
    Other Resources:
    Recent VIN Message Board discussions on lymphedema in dogs
    Drug dosages for rutin and coumarin

    Differential Diagnosis:
    Edema from hypoproteinemia
    Edema from venous stasis: heart failure, cirrhosis
    Lymphangiomatosis: diffuse or multifocal proliferation of lymphatics reported to occur rarely in the liver, skin and mammary gland of the dog




    1)  Smith Jr F W K: Lymphedema . Blackwell’s Five Minute Veterinary Consult: Canine and Feline Ames, Blackwell Publishing 2007 pp. 838-39.
    2)  Thomas JS: Diseases of Lymph Nodes and Lymphatics. Handbook of Small Animal Practice, 5 th ed. St. Louis, Saunders Elsevier 2008 pp. 690-69.
    3)  Fossum TW: Surgery of the Lymphatic System.. Small Animal Surgery, 3rd ed. St. Louis, Mosby Elsevier 2007 pp. 620-22.
    4)  Webb JA, Boston SE, Armstrong J, Moens NMM: Lymphangiosarcoma associated with primary lymphedema in a Bouvier des Flandres. J Vet Intern Med 2004 Vol 18 (1) pp. 122-124.
    5)  Schuller S, Le Garreres A, Remy I, et al: Idiopathic chylothorax and lymphedema in 2 whippet littermates. Can Vet J 2011 Vol 52 (11) pp. 1243-45.
    6)  Suami H, Suami D, Chang D W: Mapping of lymphosomes in the canine forelimb: comparative anatomy between canines and humans. Plast Reconstr Surg 2012 Vol 129 (3) pp. 612-20.
    7)  Suami H, Yamashita S, Soto-Miranda M A, et al: Lymphatic territories (lymphosomes) in a canine: an animal model for investigation of postoperative lymphatic alterations. PLoS ONE 2013 Vol 8 (7) pp. E69222.
    8)  Fossum T W, Miller M W: Lymphedema. Etiopathogenesis. J Vet Intern Med, 63 Refs ed. 1992 Vol 6 (5) pp. 283-93.
    9)  Davies A P, Hardy R, Larsen R, et al: Primary lymphedema in three dogs. J Am Vet Med Assoc 1979 Vol 174 (12) pp. 1316-20.
    10)  Firica A, Ray A, Murat J E, et al: Alleviation of experimental lymphedema by lymphovenous anastomosis in dogs. Am Surg 1972 Vol 38 (7) pp. 409-12.
    11)  Fossum TW, King LA, Miller MW: Lymphedema. Clinical signs, diagnosis, and treatment. J Vet Intern Med 1992 Vol 6 (6) pp. 312-319.
    12)  Leighton RL, Suter PF: Primary lymphedema of the hindlimb in the dog. J Am Vet Med Assoc 1979 Vol 175 (4) pp. 369-374.
    13)  Kang J H, Lee J Y, Mo I P, et al : Secondary malignant lymphoedema after mastectomy in two dogs. J Small Anim Pract 2007 Vol 48 (10) pp. 579-83.
    14)  Gill J, Lee R: Primary lymphoedema in a dog–a case report. J Small Anim Pract 1982 Vol 23 (1) pp. 13-17.
    15)  Davies C: Therapy for lymphedema. Vet Med 1998 Vol 93 pp. 659-660.
    16)  Knight KR, et al: Coumarin and 7-hydroxycoumarin treatment of canine obstructive lymphoedema. Clin Sci (Lond) 1989 Vol 77 (1) pp. 69-76.
  2. Neoplasia seems unlikely in a

    Neoplasia seems unlikely in a dog this age.

    I had an older dog with a localized swelling that turned out to be Blasto.

    The organisim was seen on cytology and the Blasto titer was high on a urine sample submitted to MiraVista Labs.

    Just another thought

  3. Neoplasia seems unlikely in a

    Neoplasia seems unlikely in a dog this age.

    I had an older dog with a localized swelling that turned out to be Blasto.

    The organisim was seen on cytology and the Blasto titer was high on a urine sample submitted to MiraVista Labs.

    Just another thought

  4. I was mainly waiting to post

    I was mainly waiting to post hoping Dr Ondreka would jump in as this is her wheelhouse. i posted on the other thread but also pinged Dr Ondreka.

Skip to content