INTRODUCTION: Lipedema is a chronic disorder characterized by localized adiposity, typically isolated to the lower extremities (LEs). The interplay between the deposition of fatty tissue associated with lipedema and impairments of lymphatic flow remains unclear. The purpose of this study is to evaluate lymphoscintigraphic findings in patients with a clinical diagnosis of lipedema in order to better characterize their lymphatic flow and whether impairments in flow contribute to the burden of disease.
METHODS: Patients with a clinical diagnosis of lipedema receiving lymphoscintigraphy between January, 2015 and January, 2017 were included in this study. Patient demographics, clinical characteristics, and lymphoscintigraphic findings were extracted. Kleinhans’ transport index (TI) was utilized to assess lymphatic flow in these patients. Scores range from 0 to 45 with higher scores indicating greater impairments in flow and transport indices greater than 9 denoting pathologic lymphatic transport.
RESULTS: A total of 8 patients (16 LEs) with a clinical diagnosis of lipedema received lymphoscintigraphic evaluation. Mean age was 55.6 and mean BMI was 35.5 kg/m2. No patients had a history of cancer diagnosis, lymph node dissection, or radiation. Severity of lipedema was classified as stage 1 in 2 patients (25%), stage 2 in 2 patients (25%), stage 3 in 2 patients (25%), and stage 4 in 2 patients (25%). Visualization of at least 1 inguinal lymph node occurred in all LE and parailliac lymph nodes were visualized in 15 (93.8%) LE. Dermal backflow was observed in 5 (31.3%) LEs. Mean TI was 8.81 (SD + 9.04). Overall, 6 (37.5%) LEs had a pathologic TI index (TI > 9) including 1 LE with stage 1, 2 LEs with stage 2, and 3 LEs with stage 3 lipedema. Mean differences in TI scores between each LE in patients was 5.00 (SD + 5.10) with 4 (50%) patients having differences of 5 or greater between legs.
CONCLUSION: Preliminary data suggests that a significant number of patients with a clinical diagnosis of lipedema have impaired lymphatic flow. Interestingly, despite the symmetric clinical profile of the disease, half of the patients in this study had notable asymmetric lymphatic flow on lymphoscintography. Understanding the lymphatic component of this disease may help guide surgical treatment.