Synopsis
Recognise lymphoedema, distinguish developmental primary disease from acquired secondary causes, exclude dangerous mimics and build a safe long-term management plan.
- Treat rapid new swelling or systemic illness as a diagnostic change: urgently exclude DVT, cellulitis or sepsis, acute ischaemia and obstructing malignancy before resuming routine care.
- Primary lymphoedema reflects a developmental lymphatic abnormality present from birth but may become clinically apparent at any age; secondary lymphoedema follows acquired damage or overload.
- Diagnosis is usually clinical after a full history, examination and repeatable limb measurement; imaging is reserved for uncertainty, proximal obstruction, surgical planning or an atypical course.
Key red flags
A hot painful erythematous limb with fever, rigors, hypotension or confusion suggests cellulitis with possible sepsis and requires prompt antimicrobial and severity assessment.
Abrupt unilateral swelling, deep tenderness, new chest pain or breathlessness requires an urgent venous thromboembolism pathway rather than attribution to established lymphoedema.
New adult-onset unilateral swelling with weight loss, pelvic or axillary symptoms, lymphadenopathy or rapid progression raises concern for malignancy or proximal obstruction.
A cold pale foot, rest pain, tissue loss, absent pulses or new neurological deficit requires urgent arterial assessment before compression is intensified.
Investigation priorities
Establish distribution, stage, skin and tissue change, functional burden and a repeatable baseline for follow-up.
Management branches
Use when swelling has lasted or recurred and an acute emergency has been excluded.
- Establish onset, tempo, distribution, variation with elevation, family history, cancer treatment, surgery, radiotherapy, trauma, infection, venous disease, medication, mobility and systemic symptoms.
- Examine both sides, including proximal regions and nodes; assess pulses, pitting, skin-fold thickness, Stemmer sign, fibrosis, skin integrity, scars, venous change and functional restriction.
Use for routine long-term care after acute infection, arterial compromise and untreated major systemic causes have been addressed.