1. Differential Diagnosis of Limb Edema The Ohio State University Lymphedema Center Experience
Steven M. Dean, DO, FACP, RPVI
Professor of Clinical Internal Medicine
Division of Cardiovascular Medicine
The Ohio State University Wexner Medical Center

2. Disclosures
Potential Conflict: Scientific Advisory Board - Tactile Medical

3. Causes of Limb Edema
OSU PT/Lymphedema clinic experience ( ): n = 472
Phlebolymphedema-36%
Cancer/Rx (Lower extremities)-23%
Mixed phlebolymphedema (CA/lipedema/primary lymphedema)- 16%
Lipedema/lipo-lymphedema-10%
Primary lymphedema-8%
Other (7%)
Preliminary Data

4. Emedicine “In the industrialized world, the most common causes of secondary lymphedema are malignancy and its treatment.”

5. “The most common form of lymphedema worldwide may be filarial infection but the most common in the Western world is phlebolymphedema”
Farrow. Phlebolymphedema- A Common Underdiagnosed & Undertreated Problem in the Wound Care Clinic. J Am Col CWS 2010;2: 14-23

6. Most common secondary cause of Lower Extremity Lymphedema?
Phlebo-
lymphedema

7. Phlebolymphedema

8. Foot/toe swelling is NOT required to make a diagnosis of lower extremity [phlebo]lymphedema!

9. …lymphatic failure is responsible for all forms of peripheral edema..

10. “All chronic edema indicates
an inadequacy or failure of lymph drainage…”
The Journal of Clinical Investigation Volume 124 Number 3 March 2014

11. chronic venous insufficiency
All edema including
chronic venous insufficiency is
actually lymphedema!

13. Always Bilateral
Symmetrical
Feet/Toe Sparing

14. Trunk is spared

15. Lymphedema vs Lipedema

16. Massive Localized Lymphedema [MLL]
“Pseudotumors”
“Pseudosarcomas ”
Brewer 2011 Ann Plast Surg pts; average weight 421 lb [ ]

17. Other “Hybrid” Limb Swelling

18. Lipedema with secondary lymphedema
“Lipo-lymphedema”

19. Lipedema with secondary phlebolymphededema
“Lipo-phlebolymphedema”

20. Lipedema with secondary phlebolymphedema
“Lipo-phlebolymphedema”

21. Lipedema with foot sparing secondary phlebolymphedema
“Lipo-phlebolymphedema”
Photo courtesy of Dr. John aka“Jerry” Bartholomew

22. “Lympho-lipedema”

23. Lipedema with secondary phlebolymphedema
“Lipo-phlebo-lymphedema”

24. Phlebolymphedema, not cancer and its associated treatment, is the most common cause of secondary lower extremity lymphedema
Foot swelling is not required to make a diagnosis of phlebolymphedema
All edema is lymphedema!
Hybrid forms of limb swelling are common