Difference between revisions of "Lymphedema"

(Differential Diagnosis)
(Differential Diagnosis)
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==Differential Diagnosis==
==Differential Diagnosis==
* Venous Insufficiency
* [[DVT]]
* Post-thrombotic Syndrome
* Hypoalbuminemia
* [[CHF]]
* Limb Hypertrophy
** Hypertrophy of soft tissue or bone (Klippel-Trenaunay syndrome)
** Overgrowth of body part (Proteus Syndrome)
* Myxedema
* Lipedema
* Tumor
{{Unilateral leg swelling DDX}}
{{Unilateral leg swelling DDX}}

Revision as of 18:15, 26 March 2019


  • Lymphedema is swelling due to abnormal accumulation of interstitial protein rich fluid and fibroadipose tissue.
  • Occurs when lymphatic load exceeds capacity in the lymphatic system



  • Congenital Lymphedema (6-12%) - before age 2
  • Lymphedema Precox (77-94%) - at onset of puberty
  • Lymphedema Tarda (11%) - after age 35


Clinical Features

  • Slowly progressive swelling, may be pitting at onset
  • Feeling of heaviness, tightness, or discomfort
  • Severe cases have dermal thickening with skin becoming dry, firm, and hyperkeratotic
    • Occurs due to cutaneous fibrosis and adipose deposition.
  • Stemmer Sign - positive if unable to pinch and lift skin at the base of second toe or finger.

Differential Diagnosis

Unilateral leg swelling

Differential Diagnosis of Pedal Edema


  • Diagnosis is primarily made clinically. See clinical features above.
  • Rule out alternative diagnoses (e.g. duplexes to rule out DVT if indicated)
  • Additional non-ED studies may include:
    • Duplex Ultrasound
    • Lymphoscintigraphy
    • Computed Tomography
    • Magnetic Resonance Imaging/Lymphography
    • Indocyanine Green (ICG) Lymphangiography
    • Genetic Testing

Clinical Staging (by International Society of Lymphology) [3]

  • Stage 0 - Asymptomatic, swelling not evident despite impaired lymphatic transport. May have feeling of heaviness in limb.
  • Stage I (mild) - Soft edema +/- pitting, no sign of dermal fibrosis, fluid accumulation subsides with limb elevation within 24 hours.
  • Stage II (moderate) - Some dermal fibrosis present, not reversible with limb elevation alone.
  • Stage III (severe) - Lymphostatic elephantiasis, skin changes such as fat deposits, acanthosis, warty overgrowths.


  • General Measures
    • Self-monitoring - for size, sensation, color, temperature, skin condition
    • Limb elevation
    • Diet and exercise - maintain ideal body weight. Recommended to use compression garments during exercise.
    • Avoid skin infection/injury
  • Compression Therapy - bandaging, garments, intermittent pneumatic compression
  • Physiotherapy - manual lymphatic drainage
    • Contraindicated in presence of cellulitis, neoplasm, DVT, moderate-severe heart failure
  • Surgical Referral


  • Discharge if uncomplicated

See Also

External Links


  1. Szuba A, Rockson SG. Lymphedema: classification, diagnosis and therapy. Vasc Med 1998; 3:145-56
  2. Cormier JN, Askew RL, Mungovan KS, et al. Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer 2010; 116:5138-49
  3. 3.0 3.1 International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46:1-11
  4. Rockson SG. Lymphedema. Am J Med 2001; 110:288-95