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➤ Screening
• Routine screening for lymphedema in asymptomatic individuals
with severe obesity is not universally recommended; however,
it should be considered in cases of unexplained extremity
swelling, disproportionate edema, or a history of cellulitis. In
such cases, clinical history and physical examination remain
central to early detection. Attention should focus on symptom
duration, progression, and history of trauma, infection, surgery,
or immobility, while adjunctive tools such as bioimpedance
spectroscopy or limb volume measurement may aid diagnosis
in high-risk or post-cancer populations. Consensus guidelines
emphasize the importance of early identif ication and intervention
to prevent lymphedema progression, particularly among those
with high BMI.
➤ Diagnosis
• Lymphedema is primarily a clinical diagnosis, characterized
by asymmetric or bilateral limb swelling, a positive Stemmer
sign, thickened, f ibrotic skin, and exclusion of systemic causes.
Diagnostic conf irmation in equivocal cases can be obtained
through lymphoscintigraphy (the gold standard), near-inf rared
fluorescence imaging, or MRI/CT to assess lymphatic dysfunction
and tissue changes, and to exclude alternative etiologies.
Diagnostic criteria f rom the American Lymphedema Framework
Project and the International Society of Lymphology require
objective evidence of impaired lymph transport, along with typical
clinical f indings. In individuals with obesity, a careful distinction
f rom lipedema or mixed edema syndromes is essential for
accurate diagnosis, which requires assessment of adipose tissue
distribution, pitting, and response to elevation.
