Which physical findings are characteristic of a patient with lymphedema?

Updated: Mar 24, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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Answer

Examination in a patient with lymphedema may reveal the following findings:

  • Nontender, pitting edema of the affected area, most commonly in the distal extremities; over time, radial enlargement of the area, progressing to a nonpitting edema

  • Erythema of the affected area and thickening of the skin, which appears as peau d'orange skin and woody edema

  • Elephantiasis nostra verrucosa (with long-term involvement): An area of cobble-stoned, hyperkeratotic, papillomatous plaques most commonly seen on the shins; the plaques can be covered with a loosely adherent crust, can be weepy or oozing a clear or yellow fluid, and/or can have a foul-smelling odor. Lymphedema from Kaposi sarcoma so severe as to be evident as elephantiasis nostras verrucose may occur. [1]

  • Fissuring, ulcerations, skin breakdown, and lymphorrhea

  • Superinfection: Common and can manifest as impetigo with yellow crusts

  • Positive Stemmer sign (inability to pinch the dorsal aspect of skin between the first and second toes)

  • Detection of early mild arm lymphedema may be facilitated by using cutaneous palpation in combination with determining the tissue dielectric constant, which evaluates local tissue water in the skin and upper subcutis, measured from fixed measurement sites. [2]

Other associated physical findings specific for the cause of secondary lymphedema and genetic disorders involving lymphedema may be noted upon examination.


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