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Lymphedema

Last reviewed: 28 Feb 2025
Last updated: 25 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • history of malignancy
  • history of travel to endemic filariasis area
  • history of previous surgery
  • history of radiation therapy
  • painless unilateral swelling of extremity or genitalia
  • involvement of distal extremity
  • positive Stemmer sign
Full details

Other diagnostic factors

  • history of penetrating trauma to the axilla or groin
  • limb heaviness and/or weakness
  • nonpitting edema
  • skin changes
  • family history of lymphedema
Full details

Risk factors

  • cancer treatment
  • nematode infection (filariasis)
  • surgery near axillary or inguinal lymph nodes
  • advanced tumor, nodes, and metastasis (TNM) stage
  • radiation therapy
  • trauma
  • curvilinear scars
  • family history of lymphedema
  • genetic syndrome
  • obesity
  • chronic venous insufficiency
Full details

Diagnostic tests

1st tests to order

  • lymphoscintigram
Full details

Tests to consider

  • MRI scan of affected extremity
  • CT scan of affected extremity
  • near infrared fluorescence imaging
  • lymphangiography
  • blood smear for filariasis
  • genetic testing
Full details

Treatment algorithm

ONGOING

all patients

Contributors

Authors

Arin K. Greene, MD, MMSc
Arin K. Greene

Department of Plastic and Oral Surgery

Boston Children's Hospital

Director Lymphedema Program

Vascular Anomalies and Pediatric Plastic Surgery Endowed Chair

Professor of Surgery

Harvard Medical School

Boston

MA

Disclosures

AKG declares that he has no competing interests. AKG is an author of a number of references cited in this topic.

Aladdin Hassanein, MD, MMSc, FACS

Associate Professor

Division of Plastic Surgery

Indiana University School of Medicine

Indianapolis

IN

Disclosures

AH declares that he has no competing interests. AH is a principal investigator in active grants on lymphedema from the United States National Institute of Health (R21, K08), Plastic Surgery Foundation, Indiana University Health.

Acknowledgements

Dr Arin K. Greene and Dr Aladdin Hassanein would like to gratefully acknowledge Dr Reid A. Maclellan, Dr Sumner A. Slavin, and Dr Carolyn C. Schook, previous contributors to this topic.

Disclosures

RAM, SAS, and CCS are authors of a number of references cited in this topic.

Peer reviewers

Hakan Brorson, MD, PhD

Senior Consultant Plastic Surgeon

Department of Plastic and Reconstructive Surgery

Lund University

Malmoe University Hospital

Malmoe

Sweden

Disclosures

HB is an author of a number of references cited in this topic.

Neil R. Feins, MD

Professor

Harvard Medical School

Senior Surgeon

Children's Hospital Boston

Boston

MA

Disclosures

NRF declares that he has no competing interests.

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