title: Learning from a lymphedema clinic: an algorithm for the management of localized swelling.
abstract: BACKGROUND
  Lymphedema is a chronic disease causing significant morbidity for affected patients. It can be difficult to diagnose, and patients are often frustrated by multiple referrals and inadequate therapies. Centralized, comprehensive care for the patient presenting with lymphedema or other causes of localized swelling allows for appropriate evaluation and provides improved management and treatment.
  
  
  METHODS
  A 4-year review of the first 100 patients seen at the Beth Israel Deaconess Medical Center Lymphedema Clinic was performed. On the basis of the clinical experience from these patients, an algorithm for diagnosing and managing patients with localized swelling was developed.
  
  
  RESULTS
  The mean age of the patients was 50 years, and 81 percent of the patients were women. On average, patients had experienced their symptoms for 11.6 years (range, 3 months to 60 years). Lymphoscintigraphy was performed on 43 patients, 81 percent of whom showed lymphatic obstruction or dysfunction. In total, 75 percent of patients were diagnosed with lymphedema based on clinical presentation or additional testing. Fourteen of these patients underwent subsequent excisional procedures, whereas the rest were managed conservatively with compression garments.
  
  
  CONCLUSIONS
  Patients presenting with swollen extremities can frequently be diagnosed through history and physical examination alone, but many patients require more extensive diagnostic workup. An algorithm for the management of these patients can facilitate evaluation and treatment.
authors.affiliation: Boston, Mass. From the Harvard Plastic Surgery Program, Harvard Medical School, and the Division of Plastic Surgery, Beth Israel Deaconess Medical Center.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Garfein
authors.forename: Loren J
authors.initials: LJ
authors.lastname: Borud
authors.forename: Anne G
authors.initials: AG
authors.lastname: Warren
authors.forename: Sumner A
authors.initials: SA
authors.lastname: Slavin
mesh_terms: D000328:Adult; D000465:Algorithms; D003937:Diagnosis, Differential; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D008209:Lymphedema / Q000000981:diagnostic imaging* / Q000628:therapy*; D008220:Lymphography; D008297:Male; D008875:Middle Aged; D009779:Occlusive Dressings; D011379:Prognosis; D011877:Radionuclide Imaging; D019651:Plastic Surgery Procedures / Q000379:methods*; D012017:Referral and Consultation; D012720:Severity of Illness Index