cardiovascular disorders
Lymphedema
Diagnosis of Lymphedema
Clinical diagnosis CT or MRI if cause is not apparent Primary lymphedema is usually obvious, based on characteristic soft-tissue edema throughout the body and other information from the history and physical examination. Diagnosis of secondary lymphedema is usually obvious from physical examination. Additional tests are indicated when secondary lymphedema is suspected unless the diagnosis and cause are obvious. CT and MRI can identify sites of lymphatic obstruction; radionuclide lymphoscintigraphy can identify lymphatic hypoplasia or sluggish flow. Progression can be monitored by measuring limb circumference, measuring water volume displaced by the submerged limb, or using skin or soft-tissue tonometry (to measure resistance to compression); these tests have not been validated. Tests for Bancroftian and Brugian Lymphatic Filariasis should be done in n tropical and subtropical areas where the infecting microfilariae are present. If lymphedema seems much greater than expected (eg, on the basis of lymph node dissection) or appears after a delay in a woman treated for breast cancer, cancer recurrence should be considered. 