Using lymphoscintigraphy to evaluate suspected lymphedema of the extremities

405 ymphedema is the painless progressive accumulation of proteinrich fluid in the interstitial spaces of the skin, resulting from an anatomic or functional obstruction of the lymphatic system [1]. Lymphedema of the lower or upper extremities is typically a chronic condition that has several possible causes and that presents considerable physical as well as psychological difficulties for patients [2]. Patients with lymphedema experience extremity swelling, decreased coordination and mobility, and secondary infections [2]. The disorder typically affects the dermis and spares the deeper compartments [3]. At the initial medical evaluation of patients with suspected extremity lymphedema, it is highly desirable for physicians to define the abnormality; to determine whether the suspected abnormality is, in fact, a lymphatic one (Figs. 1 and 2) before instituting a therapeutic plan; and to establish an objective baseline [3]. The differential diagnosis of suspected extremity lymphedema includes obesity, venous disease, and systemic disease (e.g., hypoalUsing Lymphoscintigraphy to Evaluate Suspected Lymphedema of the Extremities Mariam Moshiri 1 , Douglas S. Katz 1 , Marvin Boris 2 , Elizabeth Yung 1