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Diagnosis of Lymphedema

The diagnosis of lymphedema is an important dilemma for patients due to the lack of specialized professionals. It is common in social media networks to see the trails these patients have taken until they reach the right diagnosis. They often arrive at the correct diagnosis at a late stage, after there is evidence of fibrosis.

Thus, any patient who has edema of the toes and feet should be aware of the possibility of leg lymphedema. Women after breast cancer treatment who begin to feel their arm heavy or see swelling should be aware of the possibility of arm lymphedema.

Leg and arm lymphedema are the most common types of lymphedema. Another important sign is waking up with edema; this characterizes lymphedema when other obvious causes of edema are not present.

Regarding more objective diagnoses, the most specific test used to evaluate the lymphatic system is lymphoscintigraphy. However, this is generally only requested when the doctor has a doubt about the diagnosis. Lymphoscintigraphy may be helpful to define the type of lesion of the lymphatic system, but not in respect to treatment. This examination mainly shows changes in lymphatic vessels and lymph nodes.

Therefore, it is the first to be requested, but other volume measurements such as volumetry, measurement of the limb perimeter and bioimpedance are important to confirm and quantify the amount of edema.

Other differential diagnosis such as a venous disease and, in particular, deep venous thrombosis should be evaluated. In this case, for the specialist, the clinical history and physical examination is enough to rule out the need for a venous Doppler ultrasound examination.