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The diagnosis of lymphedema is usually based on a patient's medical history and clinical presentation. The examination includes:

• Clinical examination
• Imaging studies

Clinical Examination

In order to accurately assess the diagnosis of lymphedema, the physician must gather detailed information including:

• History of past surgery
• Time that elapsed between the surgery and the onset of lymphedema
• History of infections
• Any changes the patient noticed in the edematous limb
• Medications that the patient is taking or was taking in the recent past

In addition, the clinician will conduct a thorough examination of the patient and especially of the edematous limb and will focus on aspects such as:

• Limb assessment

  • comparison of both limbs and measurement of circumference with a tape measure at several places along the limb. Any difference between the limbs greater than 2 cm. is considered to be indicative of lymphedema.
  • is the lymphedema bilateral or unilateral?
  • is there pitting?
  • has fibrosis developed?
  • can any changes in skin texture be documented such as peau d'orange (dimpled skin)?
  • swelling in the dorsum of the foot (for lower limb lymphedema)
  • "squared off" appearance of toes in the affected foot
  • signs of hyperkeratosis (thickening of the outer layer of skin) or papillomatosis (multiple benign tumors on the skin)
  • presence of the Stemmers sign - sign is positive if one cannot pick up the flesh at the base of the 2nd toe or finger. A positive sign is an indicator of advanced lymphedema.
  • signs of infection such as cellulitis or fungus infection
  • signs of breaks in the skin, especially in the deep folds between the digits on the affected limb
  • signs of elephantiasis
  • presence of pain or discomfort (thought to be present in up to 50% of patients)
  • range of motion of the limb
  • the degree of excess limb volume
  • palpating the lymph nodes to check for signs of lymphadenopathy
  • photographs of the limb for future comparison
  • evaluation of the body quadrant to carefully assess the borders of the swelling

• Severity of Lymphedema:

  • measurement of circumference of involved limb in several places and comparison to the contralateral limb. This is the most popular and most widely used method to determine the severity of lymphedema
  • volume displacement of water - this is actually the most accurate measure for lymphedema of the upper and lower limbs
  • tissue response to pressure (tonicity) compared to the contralateral limb
  • bioelectrical impedance quantifies total body fluid and extracellular fluid in the extremity. It directly measures fluid gain or loss
  • patient questionnaires - patients self-evaluate the severity of lymphedema as it impacts on their quality of life and daily activities

Efforts are underway to standardize the diagnosis and staging of lymphedema. Many of these clinical features may help in the differential diagnosis of lymphedema. If there is a need to confirm the diagnosis or to differentiate lymphedema from swelling due to other causes, there are some imaging modalities which may be used. Imaging scans are also useful for determining the extent of remaining lymph function as well as helping determine aspects of treatment.

Imaging Studies