Diagnosis of Lymphedema

 

Stages of Lymphedema 

Latency Stage:

  • No visible/palpable edema
  • Subjective Complaints common

Stage I: 

  • Accumulation of protein-rich edema
  • Soft pitting edema that reduces with elevation

Stage II: 

  • Stasis of protein-rich edema
  • Pitting becomes firm and no longer reduces with elevation
  • Connective tissue proliferation (fibrosis)

Stage III: 

  • Stasis of protein-rich fluid
  • Fibrosis and sclerosis (severe induration)
  • Skin changes (hyperkeratosis, papillomas) 

Characteristics of benign lymphedema are:

  • Rarely painful
  • Cellulitis is common
  • Slow, progressive onset
  • Soft, pitting edema in early stages
  • Improved with elevation in early stages
  • Discomfort such as heaviness, achiness, is common
  • Ulcerations unusual unless also chronic venous insufficiency
  • Starts distally and is asymmetric (may be proximal if pelvic cancer)
  • Skin changes such as hyperkeratosis, papillomas, lichenification common


Characteristics of malignant lymphedema, cellulitis, or DVT are:

  • Pain
  • Shiny skin
  • Erythema
  • Warmth
  • Sudden onset
  • Collateral veins
  • Worse in the morning
  • Great shifts in edema from day to day
  • Proximal onset greater than distal, or no distal involvement 

 

Differential Diagnoses:

  • Lipedema
  • Malignancy
  • Chronic Venous Insufficiency
  • Acute Deep Vein Thrombosis
  • Cardiac Edema
  • Congestive Heart Failure
  • Filariasis
  • Myxedema
  • Complex Regional Pain Syndrome (CRPS, RSD, Sudeck’s Syndrome)