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Case Reports
. 2023 Jan;18(1):70-74.
doi: 10.17085/apm.22239. Epub 2023 Jan 11.

Treatment experience in a patient of complex regional pain syndrome combined with secondary lymphedema of lower extremity

Ji Hee Hong  1 , Seung Ju Kim  1
Affiliations
Case Reports

Treatment experience in a patient of complex regional pain syndrome combined with secondary lymphedema of lower extremity

Ji Hee Hong et al. Anesth Pain Med (Seoul). 2023 Jan.

Abstract

Background: Lymphedema is characterized by localized tissue swelling due to excessive interstitial space retention of lymphatic fluid. Lymphedema is easy to be misdiagnosed since itresembles other conditions of extremity swelling. We present a case of complex regionalpain syndrome (CRPS) type I with secondary lymphedema that was successfully managedwith spinal cord stimulation (SCS).

Case: A 39-year-old female patient came to our pain clinic with complaints of lower extremity pain and edema. To find out reason of leg edema, computed tomography of extremity angiography and blood test were performed. However, all of evaluations were normal. Lastlyperformed lymphoscintigraphy showed secondary lymphedema. SCS was performed and itshowed dramatic reduction subsequent to implantation of SCS.

Conclusions: We could successfully manage the intractable pain and edema in CRPS combined with lymphedema. If a patient presents different nature of edema, coexistence of other disease needs to be considered.

Keywords: Complex regional pain syndrome; Leg edema; Lymphatic fluid; Lymphedema; Lymphoscintigraphy; Spinal cord stimulation.

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Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Lymphoscintigraphy showing the lymphatic system of both extremities using Tc-99m phytate. It shows delayed lymphatic drainage of both lower extremities with the dermal back flow (right > left). RT: right, LT: left, Avg: average, Max: maximum, Min: minimum, Tot: total, R/L: right/left.
Fig. 2.
Fig. 2.
Fluoroscopic image showing the position of the electrode.
Fig. 3.
Fig. 3.
The changes of right (green) and left (yellow) side leg girth at the upper thigh (A) before and after spinal cord stimulation (SCS). The changes of right (green) and left (yellow) side leg girth at the lower calf (B) before and after SCS.
See this image and copyright information in PMC

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