Lymphoedema Diagnosis: What to Look For and How It's Done

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Diagnosis of lymphoedema involves a combination of clinical evaluation, medical history, and various diagnostic tools to assess the presence, type, and severity of swelling.

1. Clinical Evaluation first step in Diagnosis

Key Indicators:

  • Chronic swelling in limbs (often one-sided)

  • Heaviness, tightness, or reduced flexibility

  • Skin changes, such as thickening or “peau d’orange” (orange peel skin)

  • History of cancer treatment, surgery, or trauma affecting lymphatic drainage

The diagnosis often starts with:

  • Patient history (e.g., surgery, radiation, infections)

  • Physical examination, including palpation of tissues and checking for pitting

2. Volume Measurement Tools

To quantify and track the degree of swelling:

  • Tape measurement (circumference method): Comparing limb measurements to the opposite side

  • Water displacement: An older method, still useful in precise settings

  • Perometry: Infrared scanning for accurate limb volume analysis

  • Bioimpedance spectroscopy (BIS): Measures extracellular fluid levels and early signs of subclinical lymphoedema

    BIS is increasingly used in early detection, especially post-cancer treatment (e.g., breast cancer)

3. Imaging for Assessment

Used when diagnosis is uncertain or to plan treatment:

a. Lymphoscintigraphy

  • A nuclear medicine imaging technique

  • Gold standard for visualizing lymphatic drainage and identifying blockages or developmental issues

  • Injects a radioactive tracer and tracks its movement

b. Indocyanine Green (ICG) Lymphography

  • A near-infrared technique showing real-time lymphatic flow

  • Especially useful in surgical planning or detecting dermal backflow patterns

c. Ultrasound

  • Rules out deep vein thrombosis (DVT) or soft tissue changes (e.g., fibrosis, fat deposition)

  • Can detect fluid accumulation and tissue thickening

d. MRI / MR Lymphangiography

  • High-resolution imaging of lymphatic vessels

  • Can differentiate between lipedema and lymphoedema

4. Diagnostic Criteria & Staging

The International Society of Lymphology (ISL) defines stages:

  • Stage 0: Latent (no visible swelling but lymph transport is impaired)

  • Stage I: Reversible swelling with elevation

  • Stage II: Irreversible swelling with tissue changes (fibrosis)

  • Stage III: Irreversible swelling, severe skin and tissue changes

Differential Diagnosis to rule out

  • Lipedema (bilateral, painful fat disorder without pitting)

  • Chronic venous insufficiency

  • Heart, liver, or kidney disease

  • Infections, malignancies, or trauma

Who Diagnoses?

  • Lymphologists

  • Dermatologists

  • Vascular specialists

  • Trained physiotherapists or lymphoedema therapists

  • Oncology teams in post-cancer care