Diagnostics
Lymphedema proves to be very difficult to diagnose and many individuals lives are greatly impacted by their lack of diagnosis (1). The diagnosis for lymphedema is generally made clinically and a patient evaluation along with a physical examination is performed during this process. Many clinicians follow a standard diagnosis process as there is no sole method used when diagnosing an individual with lymphedema.
Who should diagnose me?
When lymphedema symptoms present themselves to an individual it is important to inform your doctor and through their assessments they can decide what the best course of action is for you (1).
There are physicians who specialize in the diagnosis and treatment of lymphedema that your doctor can refer you to (2). Your doctor may also require the assistance of a Certified Lymphedema Therapists (CLT) who can be used as an additional medical support. CLT's are not able to diagnose conditions, however they can aide the physician in the correct medical diagnosis. Usually, a healthcare team comes together to determine the appropriate course of action.
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Overview of the Diagnosis Process and the Techniques Used (1,3)
1. Family history
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Diagnosis of primary Lymphedema prevalent in the family
2. Look for symptoms
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Chronic swelling
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The physician will look to determine if the swelling is transient or persistent
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Edema that forms after an injury is not consistent with lymphedema
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Progressive atrophic skin changes
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Recurrent infections
3. History of trauma along with any surgeries the patient has undergone
4. Physical examination
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Volume and shape (circumferential) discrepancies between both the affected and non-affected limbs
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Volume can be measured through 3 techniques by tape, water displacement or perometry
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Tape measurements
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This technique is preferred for head and neck measurements
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Measurements must be made by the same person at defined intervals
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Water displacement
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This technique is preferred for extremity measurements
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Not used in the daily practice it does not delineate the daily practice
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This technique cannot be used if there is an open wound located on the limb in question
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Perometry
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This technique requires the use of an infrared optical electronic scanner to calculate the volume of the affected limb
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Expensive
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Skin changes among extremities are also used when diagnosing lymphedema, but are not used as a primary test
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5. Non-invasive measurements
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Tonometry
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Measures skin pliability, fibrosis, skin texture and resistance
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Shows how changes in affected limbs occur
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Tissue tonometer - used to evaluate tissue resistance by applying compressions
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Bioimpedance Spectroscopy (BIS)
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Assesses extracellular fluid compartment before visible changes have settled and depends on water content and fibrotic edema
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Reliable in early stage lymphedema
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6. Imaging techniques
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Lymphoscintigraphy
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Allows visualization of the superficial lymphatic flow and the functioning lymphatic vessels
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Able to detect abnormalities in lymph vessels at early stages
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Can be used for severity of disease and for preoperative-intraoperative planning
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Causes risks of damaging lymph vessels further, not commonly used
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Ultrasonography
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Shows the presence of extra fluid within tissues
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Computed tomography
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Shows the presence of extra fluid within tissues
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Magnetic resonance imaging
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Shows the presence of extra fluid within tissues
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Magnetic resonance lymphangiography
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Assists in both the diagnosis and management of lymphedema
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Requires an injection of Gadolinium into the hand and foot helping to differentiate lymphatics from veins
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Diagnosis Process Diagram (1)
References
(1) Kayiran, O., De La Cruz, C., Tane, K., Soran, A. (2017) Lymphedema: from diagnosis to treatment: Turk J Surg, 33 (2): 51-57. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508242/
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This article outlines the causes, symptoms, diagnosis, and treatment options for lymphedema. This article highlights the differences between primary and secondary lymphedema. Various diagnostic methods regarding the staging of this condition have been explained in detail such as magnetic resonance lymphangiography. Other non-imaging and non-invasive diagnostic methods such as tape measurement, water displacement and skin evaluation were also explained.
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(2) Zasadzka, E., Trzmiel, T., Kleczewska, M., Pawlaczyk, M., (2018). Comparison of the effectiveness of complex decongestive therapy and compression bandaging as a method of treatment of lymphedema in the elderly. Clin Interv Aging. 13: 929-934. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5957054/
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This article outlines a study where certified lymphedema therapists provided support to individuals with lymphedema. The study also outlines and compares the effectiveness of complex decongestive therapy and compression bandaging as a method of treatment of
lymphedema in the elderly
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(3) Greene, A. K., & Goss, J. A. (2018). Diagnosis and Staging of Lymphedema. Seminars in plastic surgery. 32(1), 12–16. https://doi.org/10.1055/s-0038-163511
Image References
(1) Kayiran O, De La Cruz C, Tane K, Soran A. (2017). Lymphedema: from Diagnosis to Treatment: Turk J Surg, 33 (2): 51-57. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508242/
​
This article outlines the causes, symptoms, diagnosis, and treatment options for lymphedema. This article highlights the differences between primary and secondary lymphedema. Various diagnostic methods regarding the staging of this condition have been explained in detail such as magnetic resonance lymphangiography. Other non-imaging and non-invasive diagnostic methods such as tape measurement, water displacement and skin evaluation were also explained.