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THE VALUE OF STEMMER’S SIGN AND LYMPHOSCINTIGRAPHIC ABNORMALITIES IN THE DIAGNOSIS OF LIPEDEMA
ISABEL FORNER-CORDERO 1, JOSE MUÑOZ-LANGA 2, MARÍA PÉREZ-POMARES 1, ANA BELÉN PONCE-GARRIDO 1, LOLA MORILLA-BELLIDO 1
1 Lymphedema Unit, Hospital Universitari i Politècnic La Fe, Associate professor, University of Valencia, Valencia, Spain
2 Oncology Unit, Hospital Peset, Valencia, Spain
Background: Lipedema is a frequently misdiagnosed disorder in women. Lipedema is characterized by bilateral enlargement of the lower limbs due to abnormal depositions of subcutaneous fat, associated with bruising and pain. Diagnostic criteria are not established yet.
Material and methods: Prospective cohort study in patients with clinical criteria of lipedema.
Aim: To describe most frequent clinical features, radiological, laboratory and hormonal values in order to set diagnostic criteria.
Results: From September 2012 to December 2014, 93 patients were included in the study.
All the patients had bilateral and symmetrical involvement; 86% disproportion with upper part of the body; 90.3% spare feet; 92.5% pain; 88.2% bruising; 82.8% absence of Stemmer sign.
The most frequent type of lipedema was Type 3, from hip-to-ankles (62.4%). The stages of lipedema were well distributed between stages I to III (I: 34.8%; II: 33.7; III: 26.1%).
Lymphoscintigraphic abnormalities were present in 40% of the patients, most of them were mild (87.5%). Patients below 40-years-old suffer more frequently from type III of lipedema (88.9%) (p=0.001). Severity of lipedema increased with the age of the patient (p<0.0001).
Stemmer’s Sign is positive in older patients (p=0.79), in more advanced stages of lipedema (p=0.003), and in patients with higher body mass index (p=0.046).
Patients with earlier stages of lipedema present with less lymphoscintigraphic abnormalities (27.8% in stage I) than patients with advanced stages (80% in stage IV) (p=0.058).
Conclusions: Although Stemmer sign and lymphoscintigraphic abnormalities are typically associated to the diagnosis of lymphedema, and have been used traditionally to differentiate both syndromes, they are present also in lipedema patients. So, their absence is not pathognomonic of lipedema.
Diagnosis has still to be made in a clinical basis.
The higher frequency of Stemmer sign and lymphoscintigraphic abnormalities in older patients and in more severe stages of lipedema suggest a lymphatic involvement with time.
THE OCCLUSION PRESSURE OF THE SUPERFICIAL LYMPHATIC NETWORK - A NEAR-INFRARED LYMPHOFLUOROSCOPIC APPROACH IN THE UPPER EXTREMITY OF HEALTHY VOLUNTEERS
BELGRADO J.-P. 1, VANDERMEEREN L. 2, VANKERCKHOVE S. 2, VALSAMIS J.-B. 1, MALLOIZEL-DELAUNAY J. 3, MORAINE J.-J. 1, LIEBENS F. 2
1 Université Libre de Bruxelles - Lymphology Research Unit, Bruxelles, Belgium 2 C.H.U. St-Pierre - Lymphology Clinic of Brussels, Belgium
3 University Hospital Rangueil, Dpt. of Vascular Medicine, Toulouse, France
Introduction: Lymphatic network as a part of the cardiovascular system is generally overlooked. Most of filtered fluids reintegrate circulation maintaining the interstitial fluid balance thanks to the lymphatic system. Lymphatic occlusion pressure could be a valuable parameter to characterize the transport capacity of lymphatic vessels. It could complete clinical reasoning in the physiopathology of edema. Former measurement techniques of lymphatic pressure in healthy humans were invasive and complex, leaving knowledge incomplete.
Near-Infrared Fluoroscopy, a minimal invasive imaging technique, allows observing superficial lymphatic flow in real time. Using a transparent sphygmomanometer cuff, we tried to determine the range of normal pressure of the superficial lymphatic vessels.
Methods: Near-infrared fluoroscopy was performed on the upper limb in 32 healthy volunteers. Lymph flow was observed through a transparent cuff, inflated by steps of 10mmHg. Optimized manual lymphatic drainage was executed during experiment to fill the observed lymphatic collectors, making sure they were stocked with lymph. Lymphatic pressure was established when lymph flow stopped.
Results: Superficial lymphatic occlusion pressure range between 80-140 mm Hg, mean 88.75 (SD 14.76). Outcomes do not highlight significant differences between age group, genders and lateralization.
Conclusions: Near infrared fluoroscopy, combined with a transparent sphygmomanometer cuff and optimized manual lymphatic drainage, is an efficient tool to determine the lymphatic occlusion pressure of the superficial lymphatic collectors. This “new” parameter could be integrated into the clinical discussion of impairment of the vascular system and more particularly in the interstitial fluid balance.
Our study pointed out that the occlusion pressure of healthy superficial lymphatic collectors in the upper limb seems to be much higher than previously described.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
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