**Core Concept**
Congenital lymphedema is a rare condition characterized by the abnormal development of lymphatic vessels, leading to chronic swelling and impaired lymphatic drainage. The primary lymphatic vessels and lymph nodes are present, but their function is compromised, resulting in lymphatic obstruction and subsequent tissue swelling.

**Why the Correct Answer is Right**
All the options A, B, and C are true about congenital lymphedema. Congenital lymphedema typically presents bilaterally (A), predominantly affects the lower limbs (B), and often manifests before puberty (C). This condition is usually diagnosed in infancy or early childhood, with the majority of cases becoming apparent before the age of 2.

**Why Each Wrong Option is Incorrect**
* **Option A:** Not applicable, as it is true that congenital lymphedema often presents bilaterally.
* **Option B:** Not applicable, as it is true that congenital lymphedema predominantly affects the lower limbs.
* **Option C:** Not applicable, as it is true that congenital lymphedema often manifests before puberty.

**Clinical Pearl / High-Yield Fact**
It is essential to note that congenital lymphedema is often associated with other anomalies, such as Turner syndrome, Klippel-Trenaunay syndrome, or Milroy disease. A thorough clinical evaluation and imaging studies are necessary to diagnose this condition accurately.

**Correct Answer Line**
✓ Correct Answer: D. None