[Lymphedema. New non-invasive methods for diagnosis and follow up]

Lymphedema is still a difficult clinical problem, poorly investigated and new methods of evaluation are needed to improve the understanding of its pathophysiology. Lymphoscintigraphy is diagnostic but cannot be repeated frequently in the follow-up. In this study we have evaluated four new methods of evaluation of lymphedema which may be used to quantify the problem and to follow-up patients. These methods are: A. the evaluation of the ratio between the concentration of lymphatic fluid proteins and plasma proteins concentration (CL/CP); B. the test of the spontaneous clearance of a haematoma; C. high-resolution ultrasound imaging of low density spaces (SBD) in the subcutaneous tissue, possibly corresponding to dilated lymphatic spaces; D. the combination of imaging and CL/CP ratio. Comparable groups of normal subjects, patients with primary lymphedema diagnosed with lymphoscintigraphy and patients with chronic venous insufficiency have been evaluated. The four methods appeared useful to differentiate normal subjects from those with lymphedema. However the separation between lymphedema and chronic venous insufficiency was less evident. Edema due to systemic causes (cardiac failure, nephrotic syndrome or chronic venous insufficiency) is also differentiated from lymphedema. In conclusion these tests may be useful to evaluate lymphedema (particularly in the early phases, when the clinical presentation is unclear), to follow-up its evolution and possibly to evaluate the effects of treatments.