Lymphedema Workup

  • Author: Don R Revis Jr, MD; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Oct 11, 2011
 

Imaging Studies

  • Although infrequently required to establish the diagnosis, certain tests may be useful to confirm the diagnosis in complex cases, to determine residual lymphatic function, to establish treatment preferences, and to evaluate therapy.
  • Lymphangiography was the criterion standard for evaluating the lymphatic system for many years.
    • This technique has been shown to cause an inflammatory reaction of the endothelium of the remaining lymphatic channels, leading to scarring, atrophy, and even luminal obliteration.
    • Lymphangiography has been replaced by less invasive techniques and should no longer be performed on patients with lymphedema.
  • Lymphoscintigraphy has replaced lymphangiography.
    • It does not promote further damage to the delicate lymphatic channels.
    • This test can be used to define anatomy and patency, evaluate dynamics of flow and reversal of flow, and determine the severity of obstruction.
  • Computed tomography (CT) scans and magnetic resonance imaging (MRI) have been advocated by some authors.
    • These tests can delineate nodal architecture at a greatly increased cost, but they have very few advantages over lymphoscintigraphy.
    • An indication for CT scan or MRI is suspicion of malignancy, for which these tests offer the most information.
  • Doppler ultrasonography is also used by some to evaluate flow in the lymphatic and venous systems.
    • The presence of a deep vein thrombosis is in the differential diagnosis of unilateral extremity swelling, and it may also occur concomitantly with lymphedema.
    • This is a very cost-effective test in the appropriate clinical situation.
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Contributor Information and Disclosures
Author

Don R Revis Jr, MD  Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine

Don R Revis Jr, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, and American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Amy L Friedman, MD  Professor of Surgery, Director of Transplantation, State University of New York Upstate Medical University College of Medicine, Syracuse

Amy L Friedman, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Medical Women's Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, Association of Women Surgeons, International College of Surgeons, International Liver Transplantation Society, New York Academy of Sciences, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of Critical Care Medicine, and Transplantation Society

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

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The body quadrants of superficial lymph drainage.
(1) Normal lymphatic flow in (a) deep systems and (b) superficial systems. Note the small collateral vessels interconnecting the 2 systems. (2) Lymphedema develops from obstruction, dilation of valves, valvular insufficiency, and subsequent reversal of lymphatic flow.
 
 
 
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