A Guide to Lymphedema: Differential Diagnosis of Lymphedema
by:Kristiana D Gordon, Peter S Mortimer, St George’s Hospital, Department of Dermatology, Blackshaw Road, London, UK
Differential Diagnosis of Lymphedema
The differential diagnosis of a swollen limb is listed in “Differential Diagnosis of Lymphedema.”[32] A thorough history, clinical examination and routine blood tests, if indicated, will exclude the majority of alternative conditions. If the clinician is still in doubt, imaging techniques, as previously mentioned, will confirm the diagnosis of lymphedema.
Lipedema
It is worth considering the diagnosis of lipedema in further detail (Figure 2). This condition is under-recognized and often incorrectly diagnosed as lymphedema or dismissed as simple obesity. Lipedema is almost certainly an inherited disorder, but the gene has yet to be identified.
Lipedema is characterized by swelling of the legs due to abnormal deposition of subcutaneous fat, associated with edema.[39]Diagnostic criteria of lipedema include[40]:
- Occurrence almost exclusively in women
- A bilateral and symmetrical nature with minimal involvement of the feet, resulting in an ‘inverse shouldering’ effect at the ankle
- Minimal pitting edema
- Pain, tenderness and easy bruising
- Persistent enlargement despite elevation of the extremities or weight loss
Microlymphography studies have demonstrated that patients with lipedema possess microlymphatic aneurysms of the lymphatic capillaries, the significance of which currently remains uncertain.[41] Lymph drainage within main leg lymphatics is relatively normal until the later stages when foot edema develops, the so-called lipedema-lymphedema syndrome.[42]
Management with exercise and compression hosiery is largely unsuccessful but can prevent progression to lymphedema.[43] It is possible that new lipoplasty techniques or surgery may improve the cosmetic appearance of this disfiguring condition.[44]
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