Diagnosing Lymphedema

At NYU Langone, our doctors are experts in detecting lymphedema, a condition affecting the lymphatic system. This network of vessels, tissues, and organs circulates lymph, a fluid that contains infection-fighting white blood cells. When there is damage to the lymphatic vessels, which carry lymph throughout the body, or the lymph nodes, the small glands that filter lymph, fluid can build up and tissues can swell, causing blockages. This condition can range from mild to severe.

Primary lymphedema is a rare genetic condition in which the lymphatic system doesn’t develop properly, causing a backup of fluid in tissues.

Secondary lymphedema develops as a result of damage to the lymphatic system. Surgery or radiation therapy for cancer, such as breast cancer or melanoma, can damage the lymphatic system. Cancer surgery may include removal of lymph nodes, which are found in the neck, underarm, abdomen, pelvis, and groin. Because lymphedema can occur after cancer treatment, your NYU Langone oncologist monitors you for signs of the condition.

Symptoms include the swelling of an arm or leg, sometimes involving fingers and toes, and a heavy or tight feeling in the affected limb or limbs. Lymphedema can cause the skin to feel thick or tight, and some people have difficulty moving an arm or leg. It can also cause itching, burning, aching, or pain. Lymphedema may lead to a skin infection, such as cellulitis, in an arm or leg.

Risk factors for cancer-related lymphedema include multiple surgeries in the affected area and infection or injury on the same side of the body as surgery to remove lymph nodes. The greater the number of lymph nodes surgically removed for cancer, the greater the risk of lymphedema.

People with obesity are more likely to develop lymphedema. Severe obesity can also cause lymphedema.

Bacterial infections such as cellulitis, which causes skin inflammation, can trigger or worsen lymphedema in people who have this condition or are at risk for developing it.

Lymphedema is a chronic condition. Although it cannot be cured, symptoms can be managed.

Diagnostic Tests

To diagnose lymphedema, your NYU Langone doctor asks about your medical history to determine risk factors and performs a physical examination. This includes measuring the circumference of your arms or legs to determine the severity of fluid buildup in affected limbs.

The doctor determines whether your symptoms, such as swelling in the arms or legs, might be caused by other conditions, such as varicose veins or blood clots, which are treated differently.

Your doctor may order an imaging test to pinpoint the cause of the fluid buildup in your body.

Lymphoscintigraphy

Lymphoscintigraphy may be used to diagnose or assess the severity of primary and secondary lymphedema. Identifying the location of fluid buildup helps your doctor create a map of how lymph flows and drains—and where it’s blocked—in the lymphatic system.

Before the scan, a small amount of harmless radioactive dye is injected into your arm. A scanner detects the movement of the dye through the lymphatic system, which your doctor monitors on a computer screen. The scan reveals the location and degree of blockages in the lymph vessels.

The test generally takes 30 minutes to several hours to complete, depending on the parts of the body being scanned.