The Challenge of a Qualitative Ultrasonographic Classification in Lipedema

Lipedema is characterized by fat accumulation in the limbs, sparing the trunk, hands, and feet. Its etiology remains uncertain, but may be related to genetic and female hormones. Several theories suggest an association with chronic inflammation and fibrosis. Pain, spontaneous bruising, and increased diameter of the affected areas are the most frequent signs and symptoms. Diagnosis is primarily clinical, but frequently supported by imaging techniques, including ultrasound, magnetic resonance imaging (MRI), dual-energy X-ray absorptiometry (DEXA), and lymphoscintigraphy to differentiate lipedema from other similar conditions. This study retrospectively analyzed ultrasonographic images of 34 female patients, clinically diagnosed with lipedema and correlated structural patterns with different stages of inflammation and fibrosis in the dermis and subcutaneous tissue. The images were obtained in 2024 using high-frequency linear transducers (12 - 15 MHz). The findings enabled the identification of potentially characteristic changes for the development of a classification that may assist in diagnosis, treatment, and monitoring of this condition. However, while ultrasonography has already been incorporated into routine medical practice to investigate lipedema, prospective and comparative multicenter studies that correlate ultrasound findings with the clinical stage of the disease are necessary to validate the applicability of this approach.