title: Differential diagnosis, investigation, and current treatment of lower limb lymphedema.
abstract: OBJECTIVE
  The causes and management of lower limb lymphedema in the Western population are different from those in the developing world.
  
  
  OBJECTIVE
  To look at the differential diagnosis, methods of investigation, and available treatments for lower limb lymphedema in the West.
  
  
  METHODS
  A PubMed search was conducted for the years 1980-2002 with the keyword "lymphedema." English language and human subject abstracts only were analyzed, and only those articles dealing with lower limb lymphedema were further reviewed. Other articles were extracted from cross-referencing.
  
  
  RESULTS
  Four hundred twenty-five review articles pertaining to lymphedema were initially examined. This review summarizes the findings of relevant articles along with our own practice regarding the management of lymphedema.
  
  
  CONCLUSIONS
  The common differential diagnosis in Western patients with lower limb swelling is secondary lymphedema, venous disease, lipedema, and adverse reaction to ipsilateral limb surgery. Lymphedema can be confirmed by a lymphoscintigram, computed tomography, magnetic resonance imaging, or ultrasound. The lymphatic anatomy is demonstrated with lymphoscintigraphy, which is particularly indicated if surgical intervention is being considered. The treatment of choice for lymphedema is multidisciplinary. In the first instance, combined physical therapy should be commenced (complete decongestive therapy), with surgery reserved for a small number of cases.
authors.affiliation: University Department of Surgery, Royal Free Hospital National Health Service Trust, London, NW3 2QG England.
authors.forename: Alok
authors.initials: A
authors.lastname: Tiwari
authors.forename: Koon-Sung
authors.initials: KS
authors.lastname: Cheng
authors.forename: Matthew
authors.initials: M
authors.lastname: Button
authors.forename: Fiona
authors.initials: F
authors.lastname: Myint
authors.forename: George
authors.initials: G
authors.lastname: Hamilton
mesh_terms: D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006358:Hot Temperature / Q000627:therapeutic use; D006801:Humans; D007866:Leg; D008068:Lipomatosis / Q000175:diagnosis; D008209:Lymphedema / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy; D008405:Massage; D010808:Physical Examination; D011312:Pressure; D020246:Venous Thrombosis / Q000175:diagnosis