Lymphatic & Venous Disorders

Lymphedema Diagnosis

Diagnosis

Lymphedema often manifests initially as a mild swelling of the affected limb. At this early time point, elevation of the limb may cause swelling to decrease. However, the limb will typically continue to increase in size; as the tissue response to lymphedema evolves, the response of the swelling to elevation will diminish and eventually completely disappear.

The clinical diagnosis of lymphedema relies most heavily upon observations made by the physician at the bedside.

The differential diagnosis of lymphedema includes both chronic venous insufficiency and lipedema.  Early lymphedema shares many features with venous insufficiency, including pitting edema, but ulcers are rarely seen in isolated lymphedema.

In lipedema, the enlargement of the lower limbs is caused by abnormal accumulation of fatty tissue below the skin surface. The feet are characteristically spared. Patients are almost exclusively female. There is likely to be a hormonal component to this disorder, but this remains poorly understood.

An underactive thyroid can also be considered in the differential diagnosis of lymphedema. This condition arises through the accumulation of protein-rich deposits in the affected limb(s). The affected limbs have reduced skin elasticity. These changes can also more rarely accompany an overactive thyroid.

History and Physical Exam

The cornerstone of your evaluation will be the analysis of your medical history and physical examination. When available to us, your outside medical records and prior studies and reports will be thoroughly reviewed. Please provide your medical records to us before your appointment. At the visit itself, the nurses and physicians will ask additional questions and carry out a detailed physical exam.

Blood Tests

Your evaluation may include the performance of specific blood tests, including (but not limited to) cell counts, measurement of various blood chemistries and markers of inflammation. We can measure many things in your blood such as salts, blood cell counts and protein markers specific to the heart (one is called BNP). In some cases, genetic testing may be recommended. In addition, we may ask you to join our ongoing studies by allowing us to collect and store some of your blood for future analysis.

Echocardiogram ("Echo")

The echocardiogram is an ultrasound scan of your heart. On the echo, we can check the heart valves, measure the thickness of the heart walls, and watch the motion of blood as it travels through the heart.

CT (CAT) Scan and Magnetic Resonance Imaging ("MRI")

In some patients with lymphatic and venous disorders, it is helpful to visualize both the veins and the body tissues by one of these painless, non-invasive X-ray examinations. The information gained from the examinations will often guide future treatment decisions.

Lymphoscintigram

Lymphoscintigraphy is the most common nuclear method of imaging in lymphatics. In the procedure, a small amount of the radioactive element technetium and a blue dye are injected just beneath the skin between the fingers or toes. For anywhere from twenty minutes to several hours, a camera and computer record the path of the radioactive material. This provides useful information on lymph clearance rates, dermal backflow, and points of blockage in the lymph system.

Bioimpedance Spectroscopy

This fast, non-invasive test sends currents of varying frequencies through the body. These currents primarily pass through the fluid in the body, not the tissue. Water is found both inside the cells and outside the cells. At lower frequencies, the current passes through the fluid outside the cells and does not penetrate the cell membrane. And at higher frequencies the current passes directly through the cell membranes. The computer then uses mathematical modeling to calculate the ratio of fluid outside of the cells and the overall water content of the body and limbs.  Because the extra fluid in lymphedema is primarily extracellular fluid, these measurements give an excellent indication of the severity of the fluid component of lymphedema.

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