Lymphoedema is diagnosed with a physical examination and looking at a patient's medical history.
Signs that we look for in diagnosing lymphoedema include
Swelling on one or both sides of the body. In most cases, lymphoedema only effects one side of the body, although it is possible for both legs to be effected.
Pitting. We test this by pressing the tissue for a 30-90 seconds. If it leaves an indentation, it indicates the presence of fluid.
Presence of fibrosis. This is when the skin becomes thickened. We use a test called the Stemmer's Sign. We try to pick up the skin in a (gentle) pinch. If we can pick it up, then it is negative for fibrosis.
Skin changes. As lymphoedema progresses, the skin may develop growths, change texture, split or stretch.
Colour and Vascular Pattern - often with skin changes, the skin can also become darker, this can also be a sign of CVI (Chronic Venous Insufficiency, a condition whereby the venous system doesn't work probably and therefore blood and lymph may pool in the lower legs)
Scarring. Scar tissue acts as a roadblock to lymphatic vessels, and can cause backfilling. Areas of radiation. Radiation therapy can damage lymphatic vessels and lymph nodes, which can block the system's ability to drain fluid from the effected part of the body.
Alongside a physical examination, we will ask questions about the following:
How long as the swelling been there
How has the swelling increased or changed
Does anyone else in the family have similar symptoms
Have you had any triggers that might cause oedema. eg: Injury, surgery, radiation therapy, hormonal changes, excessive stress
What side effects or complications are you having from the oedema.
Have you had any other treatment, what worked and what didn't work.
What treatment are you having at the moment?
What medications are you taking.
Technical Tools for Diagnosis
There are a couple of technical tools that can be used to confirm a diagnosis and assist with treatment planning, but they aren't widely available in NZ.
Indocyanine Green (ICG) Scan
Bioimpedance/L-Dex scanners (available in some private clinics)
Ultrasound can be used to look at larger lymphatic organs, but it's normally inadequate for looking at small sized lymphatic vessels. Can also be used for tumour follow up and documenting skin fibroses.
MRI or CT can be used but aren’t considered to be cost effective, except in specific range of indications.