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  • Iker, E., Mayfield, C. K., Gould, D. J., & Patel, K. M. (2019). Characterizing Lower Extremity Lymphedema and Lipedema with Cutaneous  Ultrasonography and an Objective Computer-Assisted Measurement of Dermal  Echogenicity. Lymphatic Research and Biology, 17(5), 525–530. https://doi.org/10.1089/lrb.2017.0090

    Background: Sonographic findings differ in patients with primary lipedema from those with lymphedema. This project was designed to quantify those differences and objectively characterize findings of lipedema and lymphedema in the lower extremity. Methods and Results: Patients with a clinical diagnosis of ISL stage I-II lipedema or lower extremity lymphedema that received ultrasound evaluation were included in this study. Thickness and echogenicity of the skin and subcutaneous fat layer were measured at the level of the ankle, calf, and thigh in each patient. The cohort analyzed included 12 patients with lipedema (12 lower extremities) and 10 patients with unilateral lymphedema (10 lower extremities with lymphedema and 8 lower extremities used as controls). Mean skin thickness of the ankle and calf was greatest in the lymphedema group compared to those with lipedema or controls (p < 0.01 and p < 0.01, respectively). The mean thickness of the subcutaneous fat layer of the thigh was greatest in those with lipedema (p < 0.01). Mean dermal to subcutaneous fat echogenicity ratio was decreased in those with lymphedema (ankle, 0.91; calf, 1.05; thigh, 1.19) compared to lipedema (ankle, 1.36; calf, 1.58; thigh, 1.54) and control (ankle, 1.26; calf, 1.54; thigh, 1.56) (p < 0.01, p < 0.01, and p = 0.02, respectively). Conclusions: Lymphedema appears to be associated with increased skin thickness and dermal hypoechogenicity, particularly in the distal lower extremity, compared to lipedema or controls. Conversely, lipedema may be associated with increased thickness and hypoechogenicity of the subcutaneous fat. Overall, these findings suggest that ultrasound may be an effective tool to differentiate these diseases and potentially guide treatment.

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  • Gould, D. J., El-Sabawi, B., Goel, P., Badash, I., Colletti, P., & Patel, K. M. (2020). Uncovering Lymphatic Transport Abnormalities in Patients with Primary Lipedema. Journal of Reconstructive Microsurgery, 36(2), 136–141. https://doi.org/10.1055/s-0039-1697904

    BACKGROUND:  Although lipedema is often clinically distinguished from lymphedema, there is considerable overlap between the two entities. The purpose of this study was to evaluate lymphoscintigraphic findings in patients with lipedema to better characterize lymphatic flow in this patient population. METHODS:  Patients with lipedema receiving lymphoscintigraphy between January 2015 and October 2017 were included. Patient demographics, clinical characteristics, and lymphoscintigraphic findings were extracted. Klienhan's transport index (TI) was utilized to assess lymphatic flow in patient's lower extremities (LEs).Scores ranged from 0 to 45, with values > 10 denoting pathologic lymphatic transport. RESULTS:  A total of 19 total patients with lipedema underwent lymphoscintigraphic evaluation. Mean age was 54.8 years and mean body mass index was 35.9 kg/m(2). Severity of lipedema was classified as stage 1 in five patients (26.3%), stage 2 in four patients (21.1%), stage 3 in four patients (21.1%), and stage 4 in six patients (31.6%). The mean TI for all extremities was 12.5; 24 (63.2%) LEs had a pathologic TI, including 7 LEs with stage 1 (29.2%), 3 LEs with stage 2 (12.5%), 6 LEs with stage 3 (25.0%), and 8 LEs with stage 4 lipedema (33.3%). The mean TI was significantly greater for extremities with severe (stage 3/4) lipedema than those with mild or moderate (stage 1/2) lipedema (15.1 vs. 9.7, p = 0.049). Mean difference in TI scores between each LE for individual patients was 6.43 (standard deviation +7.96). CONCLUSION:  Our results suggest that patients with lipedema have impaired lymphatic transport, and more severe lipedema may be associated with greater lymphatic transport abnormalities.

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  • Goel, P., Gould, D. J., El-Sabawi, B., Badash, I., Colletti, P. M., & Patel, K. M. (2019, September 22). Uncovering Lymphatic Transport Abnormalities in Patients with Primary Lipedema: An Update. Plastic Surgery 2019. Plastic Surgery 2019, San Diego, United States.

    Background: Although lipedema is often clinically distinguished from lymphedema, there is considerable overlap between the 2 entities. The purpose of this study was to evaluate lymphoscintigraphic findings in patients with lipedema to better characterize lymphatic flow in this patient population. Methods: This is an updated 4 year experience containing significant new information of patients with lipedema receiving lymphoscintigraphy at our institution between January 2015 and October 2017. Patient demographics, clinical characteristics, and lymphoscintigraphic findings were extracted. Klienhan’s transport index (TI) was utilized to assess lymphatic flow in patient’s lower extremities (LEs). Scores range from 0-45, with values >10 denoting pathologic lymphatic transport. Results: 19 total patients with lipedema underwent lymphoscintigraphic evaluation. Mean age was 54.8 and mean BMI was 35.9 kg/m2. Severity of lipedema was classified as stage 1 in 5 patients (26.3%), stage 2 in 4 patients (21.1%), stage 3 in 4 patients (21.1%), and stage 4 in 6 patients (31.6%). The mean TI for all extremities was 12.5. 24 (63.2%) LEs had a pathologic TI , including 7 LEs with stage 1 (29.2%), 3 LEs with stage 2 (12.5%), 6 LEs with stage 3 (25.0%), and 8 LEs with stage 4 lipedema (33.3%). The mean TI was significantly greater for extremities with severe (stage 3/4) lipedema than those with mild or moderate (stage 1/2) lipedema (15.1 vs. 9.7, p=0.049). Mean difference in TI scores between each LE for individual patients was 6.43 (SD 7.96). Conclusions: Our results suggest that patients with lipedema have impaired lymphatic transport, and more severe lipedema may be associated with greater lymphatic transport abnormalities.

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Last update from database: 11/23/24, 8:38 AM (UTC)

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