b'Table 1. Differential Diagnosis: Lymphedema versus LipedemaCharacteristics Lymphedema LipedemaLimb Involvement Unilateral or Bilateral BilateralStemmer Sign PositiveNegativeSymmetry Asymmetrical SymmetricalPitting Pitting in early stages, non-pittingNon-pittingin late stagesSkin Changes Present in severe presentation None(i.e., papilloma(s) and fibrosis)Stages 0, 1, 2, 3 1, 2, 3, 4Other Considerations May have lymphorrhea (leaking ofTenderness, easy bruising, hips to lymph) in severe cases; may haveankles distribution/involvementwounds and/or ulcers in setting of venous involvementStaging of LymphedemaThe International Society of Lymphology (ISL) utilizes STAGE III: Corresponds to the most severe grade of a staging system that refers to the physical conditionlymphedema where pitting can be absent and trophic of the extremities 20 .skin changes such as acanthosis, skin pliability and STAGE 0: Involves latent or subclinical lymphedemathickness, increased deposition of fat, and fibrosiswhere swelling may not be visibly apparent, butmay be present 20 .impaired lymph transport and subtle changes inStaging guidelines currently only refer to phenotypic subjective symptoms may be present.findings, but clinicians may consider incorporating STAGE I: Occurs when high protein fluid accumulatesother factors such as extensiveness, occurrence of and subsequently subsides with limb elevation. Pittingassociated complications, lymphatic imaging findings, of the skin may or may not be seen at this early stage.inflammation, genetic information, degree of disability, and quality-of-life issues.STAGE II: Represents progressive changes, with limb elevation being inadequate in reducing limb swelling. Pitting is most likely to occur in this stage. Figure 2. Stages of Lymphedema| Standardized Approach for the Diagnosis and Management of Lymphedema (LE) and Lymphatic Diseases (LD)|10'