Thick legs – not always lipedema

Abstract

Summary Due to its increased presence in the press and on television, the diagnosis of lipedema is on the way to becoming a trendy diagnosis for those with thick legs. Despite this, one must recognize that lipedema is a very rare disease. It is characterized by disproportional obesity of the extremities, especially in the region of the hip and the legs, hematoma development after minimal trauma, and increased pressure‐induced or spontaneous pain. Aids for making the correct diagnosis are (duplex) sonography, the waist‐hip index or the waist‐height index and lymphoscintigraphy. Important differential diagnoses are constitutional variability of the legs, lipohypertrophy in obesity, edema in immobility, edema in chronic venous insufficiency and rheumatic diseases. The symptom‐based therapy of lipedema consists of conservative (compression, manual lymphatic drainage, exercise) and surgical treatments (liposuction). Until now there is no curative therapy. Obesity is an important risk factor for the severity and prognosis of lipedema. Further studies for a better understanding of the pathogenesis of lipedema and in the end possible curative treatments are urgently needed.

An under-diagnosed cause of leg swelling

“…There is often marked disproportion between the torso and the affected limbs. Tenderness on palpation of the tissue and easy bruising and haematoma formation with only the slightest insult are also characteristic 3. Stemmers sign—the inability to pinch up a fold of skin at the base of the second toe—is absent in pure lipoedema whereas this test is positive in lymphoedema.…”

“…The true incidence of the condition is not entirely clear and figures in the literature on the subject show wide variability, possibly owing to the infrequent recognition of the condition. Overall, the condition is thought to be relatively rare3 and is distinct from simple obesity. The general physician should be aware of its existence.…”

Bildgebende Diagnostik zur Therapieplanung bei Lip- und Lymphödem

“…Im fortgeschrittenen Stadium zeigt sich ein diffuses Verteilungsmuster. [15]. In diesem Stadium kann man von einer ausgedehnten Fibrose des umliegenden Gewebes und einer Verdickung der Lymphgefäßwände ausgehen (▶Abb.…”

“…Hierfür hat sich die "Komplexe physikalische Entstauungstherapie", bestehend aus manueller Lymphdrainage, Kompressionstherapie, Hautpflege, Bewegungstherapie und Selbstmanagement, etabliert. Kommt es unter der konservativen Therapie innerhalb von 6 Monaten zu einer Verschlechterung des Erkrankungsbildes, sollte ein operatives Verfahren in Erwägung gezogen werden[15].Die operative Therapie kann hierzu in zwei grundlegende Ansätze unterteilt werden: in rekonstruktive und resezierende Verfahren. Zur Behandlung eines Lymphödems eignen sich besonders rekonstruktive, mikrochirurgische Verfahren zur Wiederherstellung eines regelrechten Lymphabflusses.…”

Bucher’s Broom and Selenium Improve Lipedema: A Retrospective Case Study

“…Ultimately, patients are fitted with a compression garment to inhibit the return of fluid to the adipose tissue [17]. Improvement in limb volume by CDT in a patient with lipedema has been demonstrated, [18] with a reduction of circumference of approximately 10% and a decrease in volume of up to three liters per leg [19,20]. Compression garments are worn to maintain the decrease in fluid achieved with CDT [13].…”