Last reviewed: 24 Aug 2023
Last updated: 08 Feb 2022



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
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • breast 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
More risk factors

Diagnostic investigations

1st investigations to order

  • lymphoscintigram
More 1st investigations to order

Investigations to consider

  • MRI scan of affected extremity
  • CT scan of affected extremity
  • ultrasound of affected area
  • lymphangiography
  • blood smear for filariasis
  • genetic testing
More investigations to consider

Treatment algorithm


all patients



Reid A. Maclellan, MD, MMSc
Reid A. Maclellan

Department of Plastic and Reconstructive Surgery

Instructor of Surgery

Children’s Hospital Boston

Harvard Medical School




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

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




AKG has received royalties from Springer Publishing as Editor of a lymphedema textbook. AKG is an author of a number of references cited in this topic.


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


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




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

Neil R. Feins, MD


Harvard Medical School

Senior Surgeon

Children's Hospital Boston




NRF declares that he has no competing interests.

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