Lipedema, obesity, and lymphedema

(A) Lipedema. The size of this individual's lower extremities became out of proportion to the rest of her body in adolescence. She complains of pain and bruising of her lower extremities. On physical examination there is increased lower extremity adipose with a cut-off at the ankle and normal appearing feet. A lymphoscintigram showed normal inguinal node uptake of radiolabeled tracer injected into the feet.

(B, C) These two females had asymptomatic, normal-appearing lower extremities as teenagers and young adults. In adulthood, they steadily gained weight and developed increased lower extremity size and swelling.

• (B) OWL: BMI of 44 and lymphoscintigram is normal.
• (C) OIL: BMI is 48 and the lymphoscintigram exhibits no inguinal uptake of tracer and dermal backflow.

(D) Primary lymphedema. This individual developed bilateral lower extremity swelling during infancy. Note significant foot enlargement and edema. Lymphoscintigram shows no uptake of radiolabeled tracer in the inguinal nodes.