Disclosures: John A. Stratton, MD: Nothing to disclose

Case Description: 73-year-old male status-post chemotherapy, right hemicolectomy, and wedge resection of pulmonary nodules presents to clinic for evaluation of gross pitting edema in both legs and left arm edema. Initially his edema was being treated with diuretics. He had also tried compression stockings which were not helping. Given the unknown cause of this diffuse swelling, further work-up was required.

Setting: Outpatient cancer rehabilitation clinic

Patient: A 73-year-old man with metastatic adenocarcinoma of the transverse colon status post right hemicolectomy and chemotherapy.

Assessment/Results: CT of the chest/abdomen/pelvis revealed metastatic disease with compression at the level of the thoracic duct. Furthermore, ultrasound identified bilateral lower extremity DVTs.

Discussion: This three limb distribution can be unique for lymphatic duct obstruction, but the patient’s lower extremities also demonstrated a pitting component which is more often characteristic of vascular rather than a lymphatic cause of edema. Edema can be multi-factorial in cancer patients and it is important to identify the offending causes, thoracic duct obstruction and multiple DVTs in this case, in order to adequately treat this condition. Both anticoagulation and complete decongestive therapy were required to improve this patient’s symptoms and function. Furthermore, compression in the setting of anti-coagulated DVTs has been demonstrated to be effective in preventing post-thrombotic syndrome and is appropriate for palliative purposes, especially when quality of life and function are greatly impacted by the edema.

Conclusion: When edema presents in an unusual clinical picture it is important to identify the underlying cause in order to adequately treat patients. In cases of severe lymphedema impacting function and quality of life, compression therapy is an appropriate and effective means of treatment, in the setting of an anti-coagulated DVT, for the purposes of palliation.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/multifactorial-three-limb-edema-in-a-colon-cancer-patient-a-case-report/