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This condition, which has the full name of 'erythrocyanosis frigida crurum puella rum' (cold reddish blueness of the legs of girls), is extremely common. It is not always recognized, being misdiagnosed as lymphoedema, vasomotor disease, arterial insufficiency, and other things. The skin of the legs is cold to the touch and exhibits patches of bluish discoloration. There may be chilblains and small superficial ulcerated areas. There is often an abnormally large amount of fat particularly above the ankle and around the tendo Achillis. For this reason it is sometimes called ' lipoedema'. The affected patches are often hypersensitive to light touch and may irritate with changes of temperature. Deeper palpation may reveal tenderness and nodularity of the underlying fat. The condition is usually symmetrical or alsmost so. The feet often remain normal. At typical case is illustrated in Figs. 14.22 and 14.23

While the term cellulitis is incorrect, it is commonly used and deserves a nosological classification. "Cellulitis is a dermohypodermosis and an oedemato-sclerous panniculopathy- It is indeed a true histangiography in which the fibroblastic reaction predominates over capillaro-veinular changes. Adipocytes of exaggerated size interpenetrate into micro- and later into macronodules marked off by more or less structured conjunctive fibrilla, thereby making treatment difficult.

Systemic causes of leg edema include idiopathic cyclic edema, heart failure, cirrhosis, nephrosis and other hypoproteinemic states. Lymphedema may be primary, or secondary to neoplasm, lymphangitis, retroperitoneal fibrosis and, rarely (in the U.S.), filariasis. Thrombophlebitis and chronic venous insufficiency are not uncommon causes. Finally, infection, ischemia, lipedema, vascular anomalies, tumors and trauma can be responsible for the swollen leg.

To the Editor.— I do not believe that Stallworth et al (228:1656, 1974) have proven their case for a definite clinical entity of "lipedema" in the patients described.The plasma lipid values seem high, but are of no significance unless the controls were patients of comparable sex, age, and mean weight; this is not stated. The origin of tissue lipid values would similarly have to be a group of middle-aged, overweight patients with fat legs but no symptoms, to make their figures valid.I have seen and treated many patients with a clinical picture identical with that described in their paper. Many of these patients have clinical evidence of past phlebitis; others do not. Both groups have episodes of painful, lumpy swellings in their legs, that may be accompanied by redness, heat, and tenderness in the affected areas. This picture frequently takes many weeks to resolve and may leave some ...

A 22 yr old woman with bilateral symmetrical enlargement of her lower extremities since the age of 11 is reported. A diagnosis of lipedema of the legs was made on the basis of history, physical examination, biopsy and phlebography. Lipedema of the legs should be included in the differential diagnosis of symmetrical nonpitting edematous lower extremities. According to Allen and Hines, the characteristic points to be made for a diagnosis of lipedema of the legs included the following: almost exclusively seen in women; always bilateral and symmetrical with minimal involvement of the feet; minimal to absent pitting edems; all parts of the limbs are involved simultaneously; persistent enlargement despite elevation of the extremities. 16% of their patients gave a family history of the disorder; 40% complained of pain in the lower extremities; and approximately half of the patients were obese. The age of onset was variable, from childhood to the sixth or seventh decade. There was no racial preponderance. No patient gave a history compatible with progressive lipodystrophy. Treatment included diet, diuretics, tight stockings, rest and elevation, and massage, but was unsatisfactory in most cases.

Lipoedema was first described by Allen and Hines (1940), and it is characterised by fat legs and orthostatic edema. Generalised obesity may be presend or absent, the mean weight of five illustrative patients in their paper ws 154.5 lbs. Allen and his co-workers (1951) then reported 119 cases of lipoedema at the Mayo Clinic from 1937 to 1946. The condition affects women almost exclusively. Hines (1952) states that the diagnosis of lipoedema can be made easily from observation: (1) The characteristic symmetrical distribution of fat in the lower half of the body, excepting the feet, and (2) the oedema of varying degrees in the more dependent portions of the legs. The condition is briefly mentioned by Martin et al. (1956). The condition is often confused with vascular diseases affecting lower extremities, and lymphoedema (Wold et al., 1951). Furthermore, these workers consider that lipoedema can be distinguished from lipodystrophy progressiva by the extensive loss of subcutaneous fat in the upper half of the body associated with deposition of fat in the buttocks and lower extremities (Whittle, 1944). Two patients are presented with lipoedema, associated with diabetes mellitus. The possibility that lipoedema may be a variatn of lipodystrophy progressive is discussed.

1. Lipoedema is described with an illustration of a recent case. 2. This condition should be distinguished from lymphoedema of the legs. 3. The differential diagnosis is discussed. 4. Comment is made on treatment.

En último término, el edema de los miembros se produce siempre a través de perturbaciones circulatorias. Estas alteraciones pueden tener un origen central o sistémico: afecciones cardiovasculares, renales, tiroideas o humorales (hipoproteinemia) y pueden también tener un origen periférico: insuficiencia venosa, linfoedema, etc. Uno de los problemas más difíciles de controlar para el médico es el edema de las piernas, de origen periférico, esto es sin relación con alteraciones cardiorrenales, tiroideas o humorales,. en otras palabras el edema consecutivo a la insuficiencia venosa que sucede como grave secuela a las flebotrombosis o flebitis, al linfoedema, etc. En los últimos años se ha avanzado bastante, sin embargo, en la prevención y en el tratamiento de estos edemas de origen periférico merced al mejor conocimiento de la fisiopatología, lo que supone un perfeccionamiento diagnóstico y a favor del uso de nuevos medios de tratamiento como ,los anticoagulantes y las vendas elásticas. Uno de los aportes más interesantes que se han hecho en el diagnóstico y diferenciación de estos sindromes es la descripción de una entidad clínica, hecha en Marzo de 1940 por dos investigadores de la Clínica Mayo: Allen y Hines que denominaron lipoedema de las piernas. Se trata de un aumento de volumen simétrico y generalizado de las piernas por aumento de los depósitos adiposos subcutáneos y por edema, que afecta casi exclusivameñte a las mujeres. A la descripción del cuadro clínico hecha en 1940 hemos sumado como antecedente bibliográfico un trabajo de conjunto que nos ha enviado directamente el Dr. Edgar v. Allen desde la Clínica Mayo, que no se ha publicado aún, y que reúne la experiencia de dicho servicio desde 1937 hasta 1946 .