Lymphedema diagnosis

While there are more tests today that provide imaging and details about the lymphatic system, some patients still struggle without a correct diagnosis for a long time.

There are two main types of lymphedema – primary and secondary.

Primary lymphedema is a disease that occurs when the lymphatic system has not developed adequately from birth due to hereditary or genetic abnormalities. Swelling and other symptoms of primary lymphedema can be seen at the time of birth or appear later in life and may not always be the first diagnosis Healthcare Professionals think about.

Secondary lymphedema is caused by trauma or damage to the lymphatic system from things such as surgery, radiation therapy or infections.

Your general practitioner (GP) or a nurse is likely to be your first contact person when you notice any signs or symptoms of lymphedema. The first step is to rule out any other reasons for your swelling.

Your GP will do a general check-up that includes a complete exam of your body, including your skin and soft tissues, lymph nodes, the function of your arteries and veins and any swollen areas. In addition, blood samples provide information about the function of your heart, kidneys, thyroid glands and blood count.

A complete physical exam and your medical history are important in determining the type of your lymphedema.

After that, your Healthcare Professional should refer you to a specialist for lymphedema to confirm the diagnosis and to develop a holistic treatment plan with you.

Your medical history and the physical exam of your body are two important elements in the diagnosis of lymphedema.

Here are some typical questions that your Healthcare Professional will ask you:

• When did you first notice any signs or symptoms?
• Does your swelling improve overnight?
• Did you have any infections?
• Do you take any medications and if so, what kind?
• Is there someone in your family with the same signs and symptoms?

Your Healthcare Professional will examine your affected limb as well. This usually includes the following steps:

1. Check-up of your skin to rule out any injuries or infections
2. Palpation of your tissue (is it hard or soft?) and lymph nodes (are they larger than usual or painful?)
3. Checking your body for other swollen areas
4. Measuring the affected area to monitor the size over time
5. Measuring your blood vessels (veins and arteries) to check your blood circulation

Medical history and examination are extremely helpful for the diagnosis of lymphedema, however, your Healthcare Professional may need request further testing in some instances. For example, during the very early stages of lymphedema or if you have other diseases that can cause swelling, other diagnostic tools can be helpful:

• Ultrasound scan – uses high-frequency waves that create a picture of your internal structures and tissues
• Lymphography – uses a radiocontrast agent that visualizes your lymphatic system under X-ray
• Lymphoscintigraphy - uses a nuclear medicine that visualizes the lymph drainage and your lymph nodes
• MRI (Magnetic Resonance Imaging) scans – uses a magnetic field to create pictures of your internal tissues and structures
• CT (Computed Tomography) scans – uses X-ray to create a detailed picture across your body

An early diagnosis of lymphedema is important for effective treatment and to prevent progression. Be aware of your body and stay in contact with your Healthcare Professional when you notice any changes or new signs and symptoms.