Lymphoedema diagnosis

There is no specific test or tool to diagnose lymphoedema. This makes the diagnosis difficult, and some patients struggle without a correct diagnosis for a long time. There are two main types of lymphoedema – primary and secondary. 

Primary lymphoedema is a rare condition that occurs when the lymphatic system has not developed adequately (or is not functioning as it should) from birth as a result of a genetic defect. Although the symptoms of primary lymphoedema often occur in early life, symptoms may also occur after years, and it may not be the first diagnosis that Healthcare Professionals think about.  

Secondary lymphoedema can occur as a result of injury or other underlying condition, and is more common than primary lymphoedema.

Your general practitioner (GP) or a nurse is likely to be your first contact person when you notice any signs or symptoms of lymphoedema. The first step is to rule out any other reasons for your swelling. 

Your GP will do a general check-up that includes a complete exam of your body, including your skin and soft tissues, lymph nodes, the function of your arteries and veins and any swollen areas. In addition, blood samples provide information about the function of your heart, kidneys, thyroid glands and blood count. 

A complete physical exam and your medical history are important in determining the type of your lymphoedema. 

After that, your Healthcare Professional may refer you to a specialist in lymphoedema to confirm the diagnosis and to develop a holistic treatment plan with you. 

Your medical history and the physical exam of your body are the main elements in the diagnosis of lymphoedema. 

Here are some typical questions that your Healthcare Professional will ask you:

• When did you first notice any signs or symptoms?
• Does your swelling improve overnight?
• Did you have any infections in the affected area?
• Do you take any medications and if so, what kind?
• Is there someone in your family with the same signs and symptoms?

Your Healthcare Professional will examine your affected limb as well. This usually includes the following steps:

1. Check-up of your skin to rule out any injuries or infections
2. Palpation of your tissue (is it hard or soft?) and lymph nodes (are they larger than usual or painful?)
3. Checking your body for other swollen areas
4. Measuring the affected area to monitor the size over time
5. Measuring your blood vessels (veins and arteries) to check your blood circulation

Your medical history and the examination of your affected limb are often enough for the diagnosis of lymphoedema. Your Healthcare Professional may need further information, for example when you have other conditions that can cause swelling or in the very early stages of lymphoedema. Several diagnostic tools can be useful in such a case: 

• Ultrasound scan – uses high-frequency waves that create a picture of your tissue from the outside
• Lymphography – uses a radiocontrast agent that visualises your lymphatic system under X-ray
• Lymphoscintigraphy - uses a nuclear medicine that visualises the lymph drainage and your lymph nodes
• MRI (Magnetic Resonance Imaging) scans – uses a magnetic field to create pictures from the inside of your body
• CT (Computed Tomography) scans – uses X-ray to create a detailed picture across your body

An early diagnosis of lymphoedema is important for effective treatment and to prevent progression. Be aware of your body and stay in contact with your Healthcare Professional when you notice any changes or new signs and symptoms.