Dermatologic Manifestations of Lymphedema Workup

  • Author: Kathleen M Rossy, MD; Chief Editor: William D James, MD   more...
 
Updated: Aug 2, 2011
 

Laboratory Studies

Analysis of blood, urine, or tissue is not needed to make the diagnosis of lymphedema. Such tests, however, help to define the underlying causes of lower extremity edema when the etiology is unclear.

Liver function, BUN/creatinine levels, and urinalysis results should be checked if a renal or hepatic etiology is suspected. Specific markers should be checked if a neoplasm is suspected. CBC count with differential should be checked if an infectious etiology is being considered.

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Imaging Studies

Imaging is not necessary to make the diagnosis, but it can be used to confirm it, to assess the extent of involvement, and to determine therapeutic intervention.

Lymphangiography is an invasive technique that can be used to evaluate the lymphatic system and its patency. Although it was once thought to be the first-line imaging modality for lymphedema, it is now rarely used because of the potential adverse effects.

Lymphoscintigraphy is the new criterion standard to assess the lymphatic system. It allows for detailed visualization of the lymphatic channels with minimal risk. The anatomy and the obstructed areas of lymphatic flow can be assessed.

Ultrasonography can be used to evaluate the lymphatic and venous systems. Volumetric and structural changes are identified within the lymphatic system. Venous abnormalities such as deep vein thrombosis can be excluded based on ultrasonography findings.

MRI and CT scanning can also be used to evaluate lymphedema. These radiologic tests can be helpful in confirming the diagnosis and monitoring the effects of treatment. They are also recommended when malignancy is suspected.

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Other Tests

A biopsy should be performed if the diagnosis is not clinically apparent, if areas of chronic lymphedema look suspicious, or if areas of chronic ulceration exist.

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Histologic Findings

Histologic findings include hyperkeratosis with areas of parakeratosis, acanthosis, and diffuse dermal edema with dilated lymphatic spaces. In chronic lymphedema, marked fibrosis and scattered foci of inflammatory infiltrate can be seen.

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Contributor Information and Disclosures
Author

Kathleen M Rossy, MD  Staff Physician, Department of Dermatology, New York Medical College, Metropolitan Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Noah S Scheinfeld, MD, JD, FAAD  Assistant Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, and New York Eye and Ear Infirmary; Private Practice

Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Optigenex Consulting fee Independent contractor

Specialty Editor Board

Abby S Van Voorhees, MD  Assistant Professor, Director of Psoriasis Services and Phototherapy Units, Department of Dermatology, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania

Abby S Van Voorhees, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, National Psoriasis Foundation, Phi Beta Kappa, Sigma Xi, and Women's Dermatologic Society

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Merck Salary Management position; Abbott Honoraria Speaking and teaching; Amgen Honoraria Review panel membership; Centocor Honoraria Consulting; Leo Consulting; Merck None Other

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

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Lymphedema in a patient with hypertension, diabetes, and impaired cardiac function.
Morbidly obese patient with lymphedema.
 
 
 
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