Investigations and diagnosis
The presence of lymphoedema is usually diagnosed on the findings of non pitting oedema, and in the absence of the more common causes of oedema such as deep vein thrombosis, infection or malignancy.r
Lymphoedema diagnosis should begin with an assessment of the patient including a patient history and a physical examination to ascertain the severity and limb function.
Patient history should include the following:r
- cancer treatment (surgery, lymph node dissection, radiotherapy, complications)
- trauma to limb
- cellulitis, infection and ulcers
- travel history.
Physical exam of the affected limb should include:r
- assessment of subcutaneous tissue
- pitting/non-pitting oedema
- tissue tone
- presence and severity of swelling - measuring circumference of affected limb (trunk or head and neck region) and compare this with unaffected limb using tape measure.
- condition of skin
- dry, cracked, infection, bruising, flaking, cellulitis
- presence of Stemmer’s sign – thickened skin at the base of the second toe or middle finger, compared with the unaffected limb indicates lymphoedema
- weight and height (BMI)
- cardiac and respiratory parameters
- joint mobility
- axillary cording.
Read more about grading of lymphoedema (including measuring guidelines and forms) on the Australasian Lymphology Association (ALA) Standards & Guidelines website.
||Trace thickening or faint discoloration
||Marked discoloration; leathery skin texture; papillary formation; limiting instrumental ADL
||Severe symptoms; limiting self care ADL
Common Terminology Criteria for Adverse Events (CTCAE) v5.0, 27 November, 2017