Diagnostic approach to lower limb edema
Open accessAbstract
Patients with lower limb edema are frequently referred to vascular specialists for evaluation. Multiple etiologies must be considered and often more than one cause may be present. Notably, the role of lymphatic system regardless of the underlying pathology has been underestimated. A thorough history and physical examination and a carefully considered laboratory and imaging evaluation are critical in differentiating causes. In this opinion article, we propose a diagnostic algorithm that incorporates a systematic approach to the patient with leg swelling and provides an efficient pathway for the differential diagnosis for this problem.
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Lymphoedema can also lead to severe infections, ulcer formation, psychosocial morbidity, and malignant transformation.
“Lymphoedema can also lead to severe infections, ulcer formation, psychosocial morbidity, and malignant transformation.104,105”
From Definition and diagnostic criteria of clinical obesity (2025) · cites this paper as [105]
The Introduction (page unavailable) says chronic edema negatively affects psychological health and quality of life, which supports the psychosocial part at a broader level than lymphoedema specifically. The Physical examination section associates ulcerations with advanced venous disease, while the paper does not say lymphoedema leads to severe infections or malignant transformation. (LLM, conf=0.84)
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Research works printed but not linked: 20
- [1]Dean SM Valenti E Hock K, et al The clinical characteristics of lower extremity lymphedema in 440 patients. J Vasc Surg Venous Lymphat Disord 2020; 8: 851– 859. 31992537
- [2]Ely JW Osheroff JA Chambliss ML, et al Approach to leg edema of unclear etiology. J Am Board Fam Med 2006; 19: 148– 160. 16513903
- [3]Evans NS Ratchford EV. The swollen leg. Vasc Med 2016; 21: 562– 564. 27738281
- [4]Trayes KP Studdiford JS Pickle S, et al Edema: diagnosis and management. Am Fam Phys 2013; 88: 102– 110. 23939641
- [5]Thaler HW Pienaar S Wirnsberger G, et al Bilateral leg edema in an older woman. Z Gerontol Geriat 2015; 48: 49– 51. 24271146
- [6]Moffatt CJ Aubeeluck A Franks PJ, et al Psychological factors in chronic edema: a case-control study. Lymphat Res Biol 2017; 15: 252– 261. 28937923
- [7]Rockson SG. Current concepts and future directions in the diagnosis and management of lymphatic vascular disease. Vasc Med 2010; 15: 223– 231. 20483987
- [8]Tiwari A Cheng KS Button M, et al Differential diagnosis, investigation, and current treatment of lower limb lymphedema. Arch Surg 2003; 138: 152– 161. 12578410
- [9]Uhl JF Chahim M Allaert FA. Static foot disorders: a major risk factor for chronic venous disease? Phlebology 2012; 27: 13– 18. 21727156
- [10]Malgor RD Labropoulos N. Diagnosis of venous disease with duplex ultrasound. Phlebology 2013; 1: 158– 161. 23482553
- [11]Garcia R Labropoulos N. Duplex ultrasound for the diagnosis of acute and chronic venous diseases. Surg Clin North Am 2018; 98: 201– 218. 29502767
- [12]Saleem T Knight A Raju S. Diagnostic yield of intravascular ultrasound in patients with clinical signs and symptoms of lower extremity venous disease. J Vasc Surg Venous Lymphat Disord 2020; 8: 634–639. 31843483
- [13]Yamamoto T Narushima M Doi K, et al Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconstr Surg 2011; 127: 1979– 1986. 21532424
- [14]Chavhan GB Amaral JG Temple M, et al MR lymphangiography in children: technique and potential applications. Radiographics 2017; 37: 1775– 1790. 29019760
- [15]Pabon-Ramos WM Raman V Schwartz FR, et al Magnetic resonance lymphangiography of the central lymphatic system: technique and clinical applications. J Magn Reson Imaging 2020 Epub ahead of print. DOI: 10.1002/jmri.27069. 32048438 · DOI
- [16]Labropoulos N Shifrin DA Paxinos O. New insights into the development of popliteal cysts. Br J Surg 2004; 91: 1313– 1318. 15376180
- [17]Levick JR Michel CC. Microvascular fluid exchange and the revised Starling principle. Cardiovasc Res 2010; 87: 198– 210. 20200043
- [18]Mortimer PS Rockson SG. New developments in clinical aspects of lymphatic disease. J Clin Invest 2014; 124: 915– 921. 24590276 PMC3938261
- [19]Internal Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 consensus document of the International Society of Lymphology. Lymphology 2013; 46: 1– 11. 23930436
- [20]Szél E Kemény L Groma G, et al Pathophysiological dilemmas of lipedema. Med Hypotheses 2014; 83: 599– 606. 25200646
Cited by
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Definition and diagnostic criteria of clinical obesity
Rubino, F., Cummings, D. E., Eckel, R. H., Cohen, R. V., Wilding, J. P. H., Brown, W. A., Stanford, F. C., Batterham, R. L., Farooqi, I. S., Farpour-Lambert, N. J., et al. (2025) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(24)00316-4 · Cited by 1,811 · see citing works
- Authors
- Gasparis, A. P., Kim, P. S., Dean, S. M., Khilnani, N. M., & Labropoulos, N.
- Affiliations
- Stony Brook Medicine (US)
- Center for Vein Restoration and Center for Vascular Medicine, Framingham, MA, USA
- The Ohio State University Wexner Medical Center (US)
- NewYork–Presbyterian Hospital (US)
- Corresponding author
- Labropoulos, Nicos
- Venue
- Phlebology: The Journal of Venous Disease
- Publisher
- SAGE Publications
- Published
- 2020-07-06
- Volume
- 35
- Issue
- 9
- Pages
- 650-655
- ISSN
- 0268-3555 (ISSN-L)
- 1758-1125
- PMC
- PMC7536506
- OpenAlex
- W3040765986
- Cited by
- 90
- References
- 0
- Citations by year
- 2026: 15 · 2025: 18 · 2024: 20 · 2023: 17 · 2022: 10 · 2021: 10
- FWCI
- 8.45
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Phlebology The Journal of Venous Disease (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Diagnosis and Treatment of Venous Diseases
- Health Sciences › Medicine › Oncology › Lymphatic System and Diseases
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- lower limb edema, leg swelling, differential diagnosis, diagnostic algorithm, lymphatic system, venous disease, lymphedema
- MeSH terms
- Diagnosis, Differential, Diagnostic Imaging, Edema, Humans, Leg, Lymphedema
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