Diagnosis of Lymphedema

Once you present to the doctor with leg swelling, the diagnosis is not always obvious. The initial impression is that you may have some type of venous disorder. Lymphedema is always confused with varicose veins or post phlebitic syndrome. However, your physician will obtain a careful history and document when the condition started. If the cause is not readily obvious from your presentation and examination, your physician will order the following tests:

Nuclear study: This radionuclide study involves the injection of a radioactive dye and following it with serial images. The radionuclide will accumulate at the site of obstruction.

Magnetic resonance imaging (MRI): MRI is often used to determine the site of blockage. It does not utilize radiation and can image soft tissues very well. The test does not always reveal the cause but may give some idea how extensive the problem is.

CT scan: CT scan is excellent at imaging the arms and groins. It can reveal the site of blockage. CT scan, however, does utilize the use of radiation and a dye.

Lymphangiogram: This old technique involves the use of a dye which is injected into a lymphatic vessel and serial images are obtained with x ray. Unfortunately, finding a lymphatic vessel can be very difficult in a swollen extremity. The test is very rarely used today, because of the availability of CT scan and MRI.



Complications of Lymphedema


When lymphedema is allowed to progress, certain complications can occur. The most common complications include:

Unattractive: Lymphedema is a very unattractive disorder. Many young individuals are affected by the condition and have to live with it for their entire life. It is a very embarrassing condition and most individual undergo social isolation and depression. The biggest frustration is that there is no cure for lymphedema and many physicians do not know what the best treatment is or how to manage it.

Infections: Infections of the skin in the affected extremity are every common in lymphedema. The skin becomes red and tender. Even the slightest trauma to the skin lead to an infection. Most of the skin infections are recurrent and need antibiotics.



Elephantiasis:
This is a disorder which is usually seen in Africa and Asia. It is a complication of a parasite infection which enters the body and plugs up lymphatics everywhere. The legs get massively swollen and ulcerate. Most of these individual need urgent medical therapy. Unfortunately, in Africa, these medications are lacking. The condition is very rarely seen in America

Lymphangiosarcoma: When lymphedema is allowed to progress for many years, a few individuals develop a very rare cancer in the extremity. This cancer of the soft tissues and lymphatic vessel (Lymphangiosarcoma) is hard to cure and unresponsive to chemotherapy.

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