Magnetic resonance lymphangiography in severe primary lymphedema of the right hand.

Magnetic Resonance Lymphangiography (MRL) enables the assessment of lymphatic morphology without direct lymphatic vessel invasion. We present the case of a 19-year-old male with a two-year history of progressive swelling of the right hand. MRL demonstrated advanced lymphedema (stage 2b) characterized by markedly impaired lymphatic function, extensive fibrotic changes, and hypertrophy of adipose tissue. These findings are consistent with primary lymphedema (lymphedema praecox). Given the severity of the disease, surgical options such as lymphatic-venous anastomosis were deemed unlikely to be beneficial. This case underscores the diagnostic and staging utility of MRL in primary lymphedema and its value in guiding therapeutic decision-making. Primary lymphedema particularly presenting with a unilateral or localized form is considered rare overall, with most reported cases involving broader limb distribution.