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Edema or swelling in a limb can be a secondary manifestation of other medical conditions and must be ruled out before a definite diagnosis of lymphedema can be established. Some of the conditions which need to be eliminated include:

• Deep vein thrombosis (DVT) - blood clot usually in the leg which causes an obstruction of venous flow and results in a swollen, warm, painful, calf. Edema is very soft and pitting in nature. It is most often seen following conditions such as recent surgery, immobility, or malignancy. The long term consequence of DVT is chronic venous insufficiency as described below.

• Chronic venous insufficiency - a condition in which the absence of or damaged valves or formation of a blood clot in the leg veins causes swelling or pooling of blood in the legs. It is also sometimes referred to as postphlebotic and postthrombotic syndrome and involves the venous networks of the lower extremities. Symptoms include:

  • aching in the legs while sitting or standing
  • chronic itching of the leg
  • discoloration of the skin (dusky blue)
  • venous engorgement
  • varicose veins

• Myxedema - a special type of edema which develops due to thyroid disease and caused by abnormal deposits of a mucinous substance under the skin. It is characterized by:

  • brittle uneven nails
  • rough skin on knees, soles of the feet, palms of the hands, or elbows
  • dull, thin hair
  • discoloration of the skin (yellow/orange)
  • reduced sweating

• Lipedema - this is associated with lower limb lymphedema and is caused by accumulation of fat in the subcutaneous regions usually between the pelvis and ankle. It is characterized by:

  • swelling of legs(s) but feet are spared
  • negative Stemmer sign - skin on the upper side of the foot at the base of the 2nd and 3rd toes can be lifted up
  • age-related - typically appears within 1-2 years of puberty
  • painful swelling
  • bruising is common
  • affects females more than males

• Recurrent cancer - edema due to recurrence of cancer is characterized by:

  • rapid development and progression
  • begins centrally in the body and not in the peripheral limbs
  • skin is not soft and pitting as it is in early lymphedema

• Swelling following arterial reconstruction for bypass surgery - this is common and often associated with thrombus in the veins of the legs. Swelling usually lasts up to 3 months.

• Congestive heart failure - loss of pumping power by the heart results in fluids collecting in the body which overwhelms the heart and causes heart failure
• Kidney failure - loss of the ability of the kidneys to perform its functions such as concentrating urine, excreting waste
• Idiopathic edema - swelling of unknown cause
• Hypoalbunemia - abnormally low concentration of albumin in the blood which results in edema of the feet, abdomen, lungs, or other areas of the body.