Confused about diagnosing lymphedema?

[nurselove757]

I see a lot of geriatrics patient with lower extremity swelling. A lot of them have chronic conditions which can cause swelling such as heart failure, kidney failure, and liver failure. However, if I want to find out whether it’s lymphedema, how can I go about it in the primary care setting? I have done my research but am still confused. For example, to confirm lymphedema, I can order Radionuclide lymphoscintigraphy. I have never seen this in practice. Is this something a basic outpatient imaging center has? Or is this something that only a vascular surgeon can order? Other two imaging options are Near-infrared fluorescence imaging (NIRF)and Magnetic resonance lymphangiography. Is this something that is done by any imaging company or is it something that can only be done at the hospital by a specialist?

[TuxnadoDO]

It's a clinical diagnosis the vast majority of times.

[Dodongo, APRN, NP]

23 hours ago, TuxnadoDO said:

It's a clinical diagnosis the vast majority of times.

Agree. I was with vascular surgery for a while and it really is a clinical diagnosis. Your history and physical exam will usually guide you to the etiology.

[nurselove757]

Consider this: Geriatric patient has a history of congestive heart failure with bilateral leg edema. They are on high dose of diuretic to relieve edema. Edema does not get better. How do I go on about figuring out whether the edema is from heart failure or lymphedema?

[TuxnadoDO]

First, expand your differential. Second, when evaluating volume status in a patient with CHF, need to consider other indices of volume status, such as jugular venous pressure, to determine if they are adequately diuresed. Volume status needs to be optimized taking the whole picture into consideration, then you can turn your attention solely to the legs. Consider chronicity, degree of pitting vs nonpitting, skin color and texture changes. Treatment of lymphedema is primarily noninvasive and doesn’t require advanced imaging in order to treat.

Reviewing this will likely help:

http://anmedhealth.org/Portals/16/Services-Images/stoll2014.pdf

[nurselove757]

On 6/20/2019 at 9:16 PM, TuxnadoDO said:

First, expand your differential. Second, when evaluating volume status in a patient with CHF, need to consider other indices of volume status, such as jugular venous pressure, to determine if they are adequately diuresed. Volume status needs to be optimized taking the whole picture into consideration, then you can turn your attention solely to the legs. Consider chronicity, degree of pitting vs nonpitting, skin color and texture changes. Treatment of lymphedema is primarily noninvasive and doesn’t require advanced imaging in order to treat.

Reviewing this will likely help:

http://anmedhealth.org/Portals/16/Services-Images/stoll2014.pdf

Thank you so much for guiding me. I will research this PowerPoint you sent me in the link.

[NRSKarenRN, BSN, RN]

Fat Disorders Resource Society has informative links re lipedema, Dercum's Disease (Adiposa delerosa) and Lipedema/Lymphedema Differentiation.