How to diagnose Lipedema?

The current way to diagnose Lipedema is mainly by clinical evaluation, where vascular diseases should be excluded, such as venous insufficiency and / or lymphatic diseases.

This is the reason why vascular evaluation is of outmost importance.

#
CLINICAL CRITERIA IN LIPEDEMA
N
Female sex
N
Presentation in puberty
N
Familiar association
N
Leg volume symmetrical increase with no feet involvement
N
Disproportion between the upper part and lower part of the body
N
Negative Stemmer sign with no or minimal pitting edema
N
Pain while touching the legs or arms
N
Psychological affectation is common
N
Frequent hematomas at minimal traumatisms

Differential Diagnosis

Differential diagnosis table

FEATURES

Physiopathology
Familiar burden
Skin

Sex

Age
Symmetry
Diet (responsiveness)
Pain
Stemmer’s Sign
Hematomas
Body disproportion

LIPEDEMA

Multifactorial

Yes
Soft
Female
Puberty
Yes
No
Yes

No

Yes
Yes

LYMPHEDEMA

Primary or secondary lymphatic disease
Only in some primary
Depends on the stage
Both
Any age
No
Yes/No
Yes/No
Yes
No
No

OBESITY

Multifactorial
Yes/No
No alterations
Ambos
Any age
Yes
Yes
No
No
No
Depends

CELULITIS

Multifactorial
No
Orange like skin
Both
Puberty
No
No
No

No

Yes/No
No

OUR CASES

Case 1.- Lipedema is ruled out.

Patient comes to consultation asking for Lipedema diagnosis. No venous insufficiency on ultrasound exploration.

No symptoms of pain, heaviness or inflammatory nodules throughout her legs

Diagnosis: Cellulitis, esthetic counselling is provided.

Case 2.- Lipedema is ruled out.

Patient ask for light heaviness of both legs.

No venous insufficiency on ultrasound exploration

Spider veins diagnosis.

Sclerotherapy treatment is provided.

Case 3.- Lipedema is confirmed.

Patient with clear diagnosis of Lipedema grade II type III associating venous insufficiency C3.

Endoablative treatment was initially provided and reductive liposuction treatment scheduled afterwards.