CLT Differential Diagnosis of Edema (Lipedema, Phlebolymphedema & Other Edemas)

Question 1

A woman has bilateral, symmetric, painful enlargement of both legs that bruises easily. Her feet are spared, with a 'cuff' at the ankles, and Stemmer sign is negative. What is the most likely condition?

Accepted Answer

Lipedema

Answer

Lipedema is a disorder of fat distribution seen almost only in women. It is bilateral and symmetric, painful, and bruises easily. The feet and hands are classically spared, leaving an ankle 'cuff', and Stemmer sign is negative unless secondary lymphedema has developed.

Question 2

What is 'lipo-lymphedema'?

Accepted Answer

Lipedema that has progressed far enough to cause secondary lymphedema

Answer

In advanced lipedema, the excess fatty tissue can overload and damage the lymphatic system until secondary lymphedema develops. When that happens, Stemmer sign may turn positive and the feet may start to swell.

Question 3

A patient with long-standing venous insufficiency has brownish hemosiderin staining around the ankles, lower-leg edema, and a positive Stemmer sign. What is the best description of this presentation?

Accepted Answer

Phlebolymphedema

Answer

In chronic venous insufficiency, high capillary filtration overloads the lymphatics until they are damaged too, giving combined venous and lymphatic failure called phlebolymphedema. Hemosiderin staining is a sign of venous disease, and a positive Stemmer sign shows the lymphatics are involved.

Question 4

A client presents with sudden, painful, warm swelling in one calf that has appeared within the past 24 hours. What should the therapist do?

Accepted Answer

Withhold MLD and compression and refer immediately for medical evaluation for possible DVT

Answer

Swelling that is sudden, one-sided, painful and warm suggests acute deep vein thrombosis until proven otherwise. MLD and compression could dislodge a clot, so the client needs urgent medical evaluation (for example, a duplex ultrasound) before any treatment.

Question 5

Which type of edema is characteristically non-pitting, is associated with hypothyroidism, and often shows up over the shins?

Accepted Answer

Myxedema

Answer

Myxedema comes from glycosaminoglycans building up in the dermis in hypothyroidism, which produces firm, non-pitting swelling, often over the shins (pretibial). It is treated by addressing the thyroid disorder, not with CDT alone.

CLT - Certified Lymphatic Therapist Practice Test

CLT - Certified Lymphatic Therapist Practice Test

CLT Differential Diagnosis of Edema (Lipedema, Phlebolymphedema & Other Edemas)