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BACKGROUND: Lipedema is a common, female-predominant disorder characterized by disproportionate, painful lower-limb adipose tissue, and it still lacks an objective biomarker, a disease-modifying therapy, or consensus on whether its core lesion is inflammatory. Its molecular literature is openly contradictory, reporting both immune enrichment and immune down-regulation in the same gluteofemoral depot. Because the dominant morbidity is pain rather than adipose mass, this ambiguity carries direct clinical cost. We therefore asked the following three questions: whether the reported molecular hallmarks survive control for cell-type composition, whether pain and adipose volume behave as separable endpoints, and what the germline architecture implies about the primary lesion. MATERIALS AND METHODS: From a theory-neutral standpoint, we reprocessed the largest publicly deposited adipose bulk RNA-seq dataset of lipedema (14 women with lipedema versus seven controls, paired by depot) with Salmon (College Park, MD: University of Maryland) and DESeq2 (Seattle, WA: Bioconductor Project), estimated cell-type composition by single-sample gene-set enrichment (ssGSEA), and refitted differential expression with leukocyte and erythroid composition covariates to test identifiability. We also synthesized published treatment cohorts (pain versus volume) and reviewed the architecture of germline genome-wide association studies (GWAS). RESULTS: There is no transcriptional lipolytic brake (ADRA2A +0.001; lipases unchanged or mildly up). The apparent immune down-regulation is not identifiable from blood content; adjusting for tissue composition reduces genome-wide-significant genes from 1,501 to four, with blood content correlated with disease at r approximately -0.7, so bulk data can neither establish nor exclude immune involvement, including the NLRP3 inflammasome. Pain and adipose volume are dissociable across treatments, so body weight is a confounded endpoint. The germline architecture reported to date (GRB14-COBLL1, VEGFA, RSPO3, ADAMTS9) is adipo-vascular and extracellular-matrix-based rather than immune, although the largest contributing study defined cases by a bioimpedance proxy rather than by clinical diagnosis. CONCLUSIONS: Lipedema's inflammatory status is currently undecidable from composition-confounded bulk tissue rather than settled, which explains the field's contradictory literature; the germline evidence, limited by its case definitions, supports as a hypothesis an adipo-vascular and connective program rather than a primary immune lesion; and pain, not weight, should anchor trials. We specify, but do not perform, the single decisive experiment - paired thigh-versus-abdomen single-nucleus RNA-seq with explicit composition control.

Lipedema is a chronic disorder characterized by the abnormal and disproportionate accumulation of painful subcutaneous adipose fat, primarily affecting the lower limbs and occurring almost exclusively in women. The aim of this controlled cross-sectional study was to compare body image, psychological distress, and psychological well-being in women with (n = 77) and without lipedema (n = 32). Psychological functioning was assessed using validated measures of depressive symptoms (PHQ-9), eating attitudes (EAT-26), perceived stress (PSS), medically unexplained symptoms (M.U.S.), psychological well-being (WHO-5), life satisfaction (SWLS), psychological flexibility (AAQ-II), pain intensity (VAS), together with measures of body image, lifetime psychological burden, maladaptive cognitive beliefs, symptom severity, and anthropometric parameters. Compared with controls, women with lipedema reported significantly greater body image dissatisfaction, perceived distress, M.U.S., depressive symptoms, disordered eating attitudes, and pain, together with lower psychological well-being, life satisfaction, and psychological flexibility (all p < 0.001). Within the lipedema group, PHQ-9 scores were significantly predicted by M.U.S. scores, maladaptive cognitions, and pain intensity (VAS), whereas EAT-26 scores were predicted by PHQ-9 scores and maladaptive cognitions. These findings indicate that lipedema is associated with a substantial psychological burden and support integrating psychological assessment and intervention into multidisciplinary care.

PURPOSE: This study aimed to compare 12-week changes in body composition and anthropometric parameters between standard-dose and lower-dose tirzepatide escalation regimens in women with lipedema, with particular emphasis on changes in fat mass and skeletal muscle mass. PATIENTS AND METHODS: This retrospective observational study included 100 women with lipedema receiving tirzepatide during routine clinical care. Participants were classified into lower-dose (n = 50) and standard-dose (n = 50) groups according to their prescribed dosing regimens, which differed in cumulative drug exposure. Body composition, anthropometric measurements, and skinfold thickness were assessed at baseline and after 12 weeks. An exploratory composite responder criterion was defined as a ≥5% reduction in fat mass combined with a <5% reduction in skeletal muscle mass, as estimated by bioelectrical impedance analysis (BIA). Between-group comparisons were unadjusted. RESULTS: Both regimens were associated with reductions in body weight, fat mass, and body fat percentage (all within-group p < 0.001). No statistically significant between-group differences were detected in these changes. The lower-dose regimen was associated with a smaller reduction in BIA-estimated skeletal muscle mass than the standard-dose regimen (-0.7 vs. -2.0 kg; p < 0.001). The exploratory composite responder criterion was met by 68% (34/50) of participants in the lower-dose group and 22% (11/50) in the standard-dose group (OR = 7.53; 95% CI: 3.08-18.44; p < 0.001). No statistically significant between-group differences were detected in anthropometric measurements or skinfold thickness changes. CONCLUSION: Both tirzepatide dosing regimens were associated with reductions in body weight and adiposity in women with lipedema. The lower-dose regimen was associated with a smaller reduction in BIA-estimated skeletal muscle mass and a higher proportion of participants meeting the exploratory composite responder criterion. These findings require confirmation in prospective controlled studies, given the non-randomized design, differences in cumulative drug exposure, and potential residual confounding.

Lipedema and obesity are often misdiagnosed or clinically confused yet arise via distinct mechanisms, complicating diagnosis and treatment. This review synthesizes evidence differentiating these conditions across genetic, hormonal, inflammatory and mechanical pathways to identify therapeutic targets. Lipedema may involve genetic predisposition (forkhead box C2 [FOXC2], prospero homeobox 1 [PROX1]), hormonal dysregulation with aberrant aromatase activity, and altered adipogenesis (peroxisome proliferator-activated receptor gamma [PPARγ], CCAAT/enhancer-binding protein [C/EBP]). A proinflammatory microenvironment with macrophage M1/M2 imbalance, elevated interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), and extracellular matrix remodeling is hypothesized to drive fibrosis. Emerging evidence implicates gut-derived endotoxemia (lipopolysaccharide [LPS]-toll-like receptor 4 [TLR4]-nuclear factor kappa-B [NF-κB]) and mechanotransduction (Yes-associated protein [YAP]/transcriptional coactivator with PDZ-binding motif [TAZ]) in adipocyte hypertrophy and treatment resistance. Obesity involves systemic metabolic dysfunction with visceral adiposity and cardiometabolic comorbidities. Lipedema patients maintain metabolic health, exhibit gluteofemoral fat distribution and experience neuropathic pain via nociceptor sensitization (transient receptor potential vanilloid 1 [TRPV1] and ankyrin 1 [TRPA1]) with central amplification. Weight-loss interventions are ineffective, necessitating targeted strategies. Promising targets include TLR4 antagonism, vascular endothelial growth factor C/vascular endothelial growth factor receptor-3 (VEGF-C/VEGFR3) modulation for lymphatic enhancement, YAP/TAZ inhibition and neuromodulators for pain. Physical therapy functions as a biological modifier targeting inflammation, lymphatic drainage and mechanotransduction. This review highlights promising but largely hypothesis-generating molecular insights and calls for validated biomarkers, rigorous clinical trials, and mechanism-based therapies. Many of the pathways discussed require further confirmation in human studies.

Background: Lipedema is a chronic disorder of subcutaneous adipose tissue characterized by symmetrical fat accumulation in the extremities, pain, and orthostatic edema. Objectives: This study aimed to assess whether high-resolution cutaneous ultrasound can detect measurable tissue-level changes in subcutaneous tissue over six months. Methods: A retrospective, single-center, real-world longitudinal observational cohort study was conducted in 60 women with lipedema followed at three timepoints (baseline, 3 months, 6 months). High-resolution ultrasound (18–20 MHz) measured subcutaneous and dermal thickness at standardized anatomical sites. Results: All primary ultrasound parameters decreased significantly over six months of conservative multicomponent management, which included individualized nutritional counseling and physical activity. Medial proximal thigh subcutaneous thickness declined by 18.7% (48.2 to 39.2 mm; p < 0.001). Edema prevalence fell from 100% to 55.0%. Echogenicity improved significantly between 3 and 6 months, suggesting a delayed structural remodelling effect distinct from early volumetric reduction. Ultrasound reductions were inversely correlated with weight loss, suggesting that ultrasound captures tissue-level information not fully reflected by anthropometric measures alone. Conclusions: Standardized cutaneous high-resolution ultrasound detected consistent tissue-level modifications over six months of routine clinical follow-up, capturing changes beyond anthropometric measures and representing a candidate monitoring tool warranting evaluation in controlled study designs.

Background: Lipedema is a chronic progressive condition affecting approximately 10% of women, characterized by disproportionate subcutaneous adipose tissue accumulation and pain in the lower extremities. Standardized assessment methods for pain evaluation in lipedema remain limited. The Progressive Pain Check (PPC) method represents a potentially valuable tool for standardized pain assessment in lipedema patients. Objective: To evaluate the inter-rater reliability of the PPC method for clinical assessment of evoked pain in lipedema patients. Methods: Two independent assessors performed PPC evaluations. Inter-rater reliability was assessed using the Intraclass Correlation Coefficient [ICC(2,1), two-way random-effects, absolute agreement, single-measurement] with 95% confidence intervals (CI). Results: This study included 429 women diagnosed with lipedema (mean age 41.2 ± 11.5 years, mean disease duration 27.2 ± 12.6 years). Patient characteristics revealed mean BMI of 29.5 ± 6.9 kg/m2, predominantly Type III lipedema presentation, and disease onset during adolescence (mean age 14 ± 9.3 years). The PPC method demonstrated excellent inter-rater reliability between two independent assessors across all examined anatomical districts. Conclusions: The PPC method shows promise as a simple, repeatable, and standardized clinical tool for evoked pain assessment in lipedema patients. The demonstrated inter-rater reliability supports its potential utility in clinical practice. Further research is warranted to evaluate its intra-rater reliability, concurrent validity, and responsiveness in monitoring treatment effects.

The aesthetic-functional planning of the lower limbs is frequently conducted empirically, using idiosyncratic markings and limited standardization among specialists who work in this field. The absence of a common topographic language restricts clinical communication, technical reproducibility, documentation of results, and the integration between the aesthetic approach and the vascular/lymphatic assessment of the segment. This is a descriptive study of methodological development. Based on a review of the anatomic and surgical literature and prospective clinical application during body-contour consultations, six topographic zones of the lower limbs were defined: gluteal, trochanteric (saddlebag), thigh (anterior, medial, and posterior subunits), knee, crural (calf), and talocrural (ankle), each delimited by reproducible surface bony and muscular landmarks. Onto this map, the cartography of the zones of adherence, superficial and deep adipose planes separated by the superficial fascia, saphenous venous axes, and main lymphatic collector pathways was overlaid. A four-stage marking protocol was defined (orthostatism, marking of bony landmarks, zone delimitation, and coding of plane and intensity), with standardized photographic documentation. For each zone, the following are presented: anatomic boundaries, muscular and adipose content, vascular and lymphatic correlates, zones of adherence to be preserved, recommended working plane (deep, intermediate, or superficial), specific risks, and expected aesthetic outcomes. The map provides a common nomenclature among surgeons and enables technology to be prescribed by anatomic zone rather than by generic "region". This anatomofunctional zone-based marking provides a simple, low-cost, and reproducible instrument to structure the therapeutic planning of the lower limbs, aligning the aesthetic objective with the anatomic, vascular, and lymphatic constraints of the segment. Interobserver reliability studies and comparative clinical outcome studies are the necessary next step toward validation.

Lipedema is an underdiagnosed disorder that is frequently misclassified as obesity, resulting in delayed diagnosis and inappropriate management. Despite increasing clinical interest, population-level awareness of lipedema remains poorly understood.

Introduction: Low-carbohydrate diets (LCDs) have been suggested as a potential treatment option for females with lipedema, due to their superiority in reducing pain, possibly through improvements in insulin dynamics. Objectives: The objective of this secondary analysis was to compare changes in markers of glucose and insulin dynamics after a low-carbohydrate versus low-fat low-energy diets in females with lipedema and obesity. A secondary objective was to investigate potential associations between changes in glucose and insulin dynamics and changes in pain.Methods: Females with obesity and lipedema were randomized to either an LCD or a low-fat low-energy diets (1200 kcal/day for both; 75 vs. 180 g carbohydrates/day) for 8 weeks. Basal and postprandial (total and incremental area under the curve (tAUC and iAUC)) concentrations of glucose, insulin, glucose-dependent insulinotropic polypeptide (GIP), and C-peptide were measured before and after the intervention, and HOMA-IR, Matsuda index and insulin clearance calculated.Results: A total of 70 females (35 in each group, age 47 ± 11 years, BMI 37 ± 5 kg/m2) were included in the analysis. Both groups lost body weight, but with a significantly greater weight loss in the LCD group. Both groups showed ed a reduction in basal glucose, C-peptide, and insulin concentrations, with a greater reduction in glucose on the LCD. A significant increase in glucose iAUC, C-peptide iAUC, insulin clearance, and Matsuda index was observed in the LCD group only. Both groups experienced an increase in GIP tAUC, as well as a reduction in HOMA-IR, with no significant differences between groups. No associations were seen between changes in glucose and insulin measures and changes in pain.Conclusion: Both diets improved insulin dynamics in females with lipedema and obesity, despite additional benefits in the LCD group. However, changes in the measured indices of insulin dynamics were not associated with pain reduction, suggesting that the effects of the LCD on pain and systemic metabolic regulation may involve other pathways.

BackgroundLipedema is a chronic adipose tissue disorder characterized by a disproportionate accumulation of painful subcutaneous fat on the extremities. Manual lymphatic drainage (MLD) is routinely used as therapeutic intervention, but its immediate physiological effects remain unclear. We evaluated the immediate impact of MLD on tissue composition in Lipedema using multiparametric Magnetic-resonance-imaging (MRI).Materials and MethodsFifteen women with Lipedema (5 women each for stages I/II/III; median age 43.7 [20.4–68.8] years), thirteen with lower-limb lymphedema (3/5/5 women for stages I/II/III; median age 57.6 [18.6–70.4] years) underwent quantitative MRI of the legs including volumetry, sodium MRI, proton-densitiy fat-fraction (PDFF), T1, T2 and fat-suppressed T2 mapping before and after a standardized 1 h MLD session. Five normal controls (median age 41.9 [23.3–66.2] years) were examined only before MLD. Regions of interest in skin, subcutaneous adipose tissue (SAT), and muscle were analyzed. Pain was assessed by numeric rating scale (NRS). Wilcoxon tests and Spearman correlations were applied to test for differences pre- and post-MLD as well as for associations between measurements and clinical parameters (p < 0.05).ResultsAt baseline, women with Lipedema showed higher tissue sodium and water-sensitive MRI measures compared to controls (skin sodium: median 17.7 vs. 12.3 mmol/L, p < 0.001; skin T2: 56 vs. 37 ms, p = 0.03), though lower than lymphedema (skin sodium: 32.1 mmol/L, skin T2: 70 ms). Tissue sodium in women with Lipedema correlated with clinical stage (r = 0.775, p = 0.001) and pain intensity (r = 0.656, p = 0.01). After MLD, perceived pain intensity decreased (median NRS 2 → 0, p = 0.007) and edema-related MRI metrics including tissue sodium decreased in women with Lipedema (skin sodium: 17.7 → 14.8 mmol/L, p = 0.001; skin T2: 56 → 43 ms, p = 0.001). Parameter changes in the same direction after MLD were detected in women with Lymphedema (skin sodium: 32.1 → 27.1 mmol/L, p = 0.001; skin T2: 70 → 61 ms, p = 0.001).ConclusionManual lymphatic drainage produces immediate, quantifiable changes in treated tissue in women with lipedema, indicating mobilization of sodium-rich interstitial fluid.

Lower extremity swelling has a broad differential diagnosis, including lymphedema, obesity-induced lymphedema, phlebolymphedema, and lipedema. Although these conditions may appear similar clinically, their pathophysiology and lymphoscintigraphic findings differ. Obesity, venous insufficiency, and abnormal adipose tissue can complicate image interpretation. We present four representative cases to illustrate characteristic imaging patterns across these conditions. These cases highlight the importance of interpreting lymphoscintigraphy in a clinical context.

Hyperechoic subcutaneous nodules in lipedema may mimic angiolipomas but represent an inflammatory and hypoxic-ischemic process rather than a neoplasia, despite tissue expansion. As the painful nodules expand, biopsy is recommended to exclude cancer. In this context, ultrasound (US) has become a pivotal tool for diagnosing and managing these nodules when combined with histopathologic assessment. However, many professionals in the field still have limited knowledge of this topic. In the present case series, the US and histopathologic findings of hyperechoic nodules in two patients with lipedema were compared with those observed in two patients with angiolipoma, with the aim of proposing US criteria to distinguish between these entities and highlighting the importance of accurate differential diagnosis.

ObjectiveThis study aimed to investigate central sensitization (CS) in individuals with lipedema using pressure pain threshold measurements and to examine its relationship with clinical features, sonographic findings, body composition, and Central Sensitization Inventory (CSI) scores.MethodsA total of 61 female patients with lipedema and 20 healthy controls were included in this cross-sectional study. Pressure pain threshold (PPT) was assessed at the thigh, pretibial region, and forearm using a manual algometer. Sonographic subcutaneous fat thickness was evaluated, and body composition parameters were assessed using bioelectrical impedance analysis. Clinical outcomes related to CS-including the CSI, Visual Analog Scale (VAS), Lower Extremity Functional Scale (LEFS), Short Form-12 (SF-12), and the Extended Nordic Musculoskeletal Questionnaire (NMQ-E)-were recorded. Linear mixed-effects models were used to compare PPT across groups, anatomical sites, and disease stages. Associations between PPT, CSI scores, body composition parameters, sonographic findings, and clinical measures were evaluated using Pearson correlation analyses.ResultsPatients with lipedema exhibited significantly lower PPT values across all anatomical regions, including the forearm, and significantly higher CSI scores compared with healthy controls (p < .001). Sonographic assessment confirmed increased subcutaneous fat thickness in the lower extremities of lipedema patients. Lipedema stage was not associated with overall PPT levels. However, lower forearm PPT and LEFS scores were observed in more advanced stages. Forearm PPT showed significant negative correlations with lean body mass, body fat mass, and total body water (p < .05), while no other significant associations were identified.ConclusionIndividuals with lipedema demonstrate features consistent with CS, characterized by reduced PPTs in both affected and non-affected regions together with elevated CSI scores. These findings suggest that altered pain processing may contribute to the widespread pain and functional limitations observed in lipedema, highlighting the importance of comprehensive assessment of CS in this population.

Objective: Lipedema is a chronic adipose tissue disorder characterized by bilateral and symmetrical subcutaneous fat accumulation, predominantly affecting women. Because it is frequently confused with obesity and lymphedema, diagnosis may be delayed. This proof-of-concept study aimed to evaluate the feasibility of LipoAssist, a structured GPT-4–based clinical workflow designed for the preliminary assessment of lipedema under simulated conditions. Methods: Ten simulated clinical scenarios representing lipedema and relevant differential diagnoses were evaluated using LipoAssist. The workflow was designed to obtain a structured medical history, assess clinically relevant symptoms, and generate a standardized case summary. Three board-certified Physical Medicine and Rehabilitation specialists independently evaluated the AI-generated outputs using a 5-point Likert scale across six criteria. A total of 180 ratings were analyzed. Inter-rater agreement was assessed using the intraclass correlation coefficient and Kendall's coefficient of concordance. Results: The overall mean performance score was 3.55 ± 0.64. The highest scores were observed for correct understanding of the clinical condition (4.63 ± 0.49) and identification of the most likely diagnosis (4.53 ± 0.51). Lower scores were recorded for recommendations regarding further diagnostic evaluation (2.17 ± 0.83) and assessment of surgical necessity (1.93 ± 0.64). Case-summary clarity and adequacy of history taking received mean scores of 3.87 ± 0.63 and 3.73 ± 0.64, respectively. Inter-rater agreement was good (ICC = 0.82; 95% CI: 0.68–0.91), and Kendall's W was 0.79. Conclusion: LipoAssist demonstrated promising performance in structured history taking, organization of clinical information, and identification of the most likely diagnosis in simulated lipedema scenarios. However, its performance was limited in advanced diagnostic recommendations and surgical decision-making. These findings support the feasibility of a structured GPT-4–based workflow under simulated conditions but do not establish clinical validity, diagnostic accuracy, or readiness for routine implementation.

OBJECTIVE: To evaluate ultrasonographic changes in lower extremity tendons and plantar fascia of patients with chronic edema and their relationship with edema volume, pain, function, and quality of life. DESIGN: This observational case-control study included 53 patients with chronic lower extremity edema and 55 age- and sex-matched controls. Ultrasonography assessed the Achilles, tibialis posterior, peroneal, and patellar tendons and plantar fascia. Edema volume was calculated from limb circumferences. Outcomes included the Lower Extremity Functional Scale (LEFS), Lymphedema Quality of Life Questionnaire-Leg (LYMQOL-Leg), and Visual Analogue Scale (VAS). RESULTS: All tendons (except the patellar tendon) and plantar fascia were thicker in the edema group than controls ( P <0.05). Differences in Achilles tendon and plantar fascia thickness remained significant after BMI adjustment (all P <0.01) and correlated positively with edema volume ( P <0.05). Plantar fasciitis (50.9%) and Achilles tendinopathy (22.6%) were more frequent in the edema group ( P <0.05). Patients had lower LEFS and higher LYMQOL-Leg and VAS scores (all P <0.01). CONCLUSION: Chronic lower extremity edema was associated with alterations in tendon and fascial morphology, particularly the Achilles tendon and plantar fascia. Musculoskeletal ultrasonography may complement clinical evaluation by providing information regarding tendon and fascial involvement.

BACKGROUND: Lipedema is a chronic adipose tissue disorder primarily affecting women, characterized by abnormal fat accumulation, pain, and reduced mobility. Its impact on sexual function remains underexplored. This study aimed to evaluate sexual function in women with lipedema and examine its associations with anxiety, depression, lower extremity function, and quality of life. METHODS: In this cross-sectional study, 100 sexually active women were recruited: 50 with lipedema and 50 age- and Body Mass Index-matched healthy controls. Sexual function was assessed with the Female Sexual Function Index (FSFI); anxiety and depression with the Hospital Anxiety and Depression Scale (HADS-A and HADS-D); quality of life with the EuroQOL 5-Dimensional 5-Level (EQ-5D-5L) instrument; lower extremity function with the Lower Extremity Functional Scale (LEFS); and pain intensity with the Visual Analog Scale (VAS). Multiple linear regression analysis was conducted to identify the factors associated with the total FSFI score. RESULTS: Women with lipedema had significantly lower total FSFI scores compared to controls (21.58 ± 3.99 vs. 25.86 ± 3.21, P < .001), with 76% having FSFI scores below the cut-off (≤ 26.55) compared to 36% of controls. All FSFI domain scores were significantly lower in the lipedema group (all P < .05). In the lipedema group, there was a significant correlation between total FSFI scores and age (P = .002), pain intensity (VAS; P = .022), depression (HADS-D; P = .010), quality of life (EQ-5D-5L index; P = .027), and lower extremity function (LEFS; P < .001). Multiple linear regression analysis identified depression (HADS-D; P = .047), perceived health status (EQ-5D-5L VAS; P = .033), and lower extremity function (LEFS; P = .011) as independent variables that had a significant relationship with the total FSFI score. DISCUSSION: Lower sexual function is common among women with lipedema and is associated with anxiety and depressive symptoms, lower extremity function, and pain intensity. These findings highlight the importance of incorporating sexual function assessment into the routine evaluation of patients with lipedema and support the need for comprehensive multidisciplinary treatment approaches addressing physical, psychological, and sexual health aspects of care.

BACKGROUND: Lipedema is a chronic disorder characterized by excessive, bilateral, and symmetrical deposition of subcutaneous adipose tissue, predominantly in the lower extremities. Despite its prevalence, lipedema is frequently misdiagnosed as lymphedema, and lymphoscintigraphy is commonly used to differentiate between the two. This systematic review synthesizes the available evidence regarding the most common lymphoscintigraphy findings in patients with lipedema. METHODS: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed across the MEDLINE/PubMed, Embase, and Web of Science databases. Studies were included if they reported lymphoscintigraphy findings in patients with lipedema and provided a clear description of the imaging protocol. Extracted data included patient demographics, lymphoscintigraphy protocols, and imaging findings. RESULTS: Seven studies met the inclusion criteria, encompassing 470 patients, of whom 311 had lipedema. The mean age was 47.4 years, and all patients were women. The mean body mass index was 32.6 kg/m2. Lymphoscintigraphy findings were normal in 61.4% of patients with lipedema. Tortuous lymph vessels were the most common abnormality (56.8%), followed by collateral lymph vessels (49.1%) and popliteal node visualization (44.0%). Dermal backflow (3.8%) and secondary lymphedema (11.8%) were less frequent. CONCLUSIONS: Lymphoscintigraphic alterations in patients with lipedema seem to reflect lymphatic overload rather than frank insufficiency. However, significant heterogeneity in study methodologies precluded a quantitative meta-analysis. Future research should focus on establishing standardized, consensus-based imaging protocols to better define the role of lymphoscintigraphy in the diagnosis and staging of lipedema.

Lipedema is a chronic progressive disease characterized by disproportionate and symmetric adipose tissue accumulation, predominantly affecting women, with upper extremity involvement (Type IV) in approximately 30% of cases. This study aimed to evaluate ultrasound measurements of subcutaneous tissue thickness in the upper extremities of women with lipedema compared with matched controls and to establish diagnostic cutoff values for this region.MethodsCross-sectional case-control study including 102 women (51 with clinically diagnosed lipedema and 51 age- and BMI-matched controls). Bilateral ultrasound measurements were obtained at six standardized anatomical points on the upper extremities, and subcutaneous thickness was measured from the dermal-epidermal junction to the deep fascia. Receiver Operating Characteristic (ROC) curves were used to derive diagnostic cutoff values.ResultsSubcutaneous thickness was significantly greater in the lipedema group at all sites, independent of BMI (p < .05). The mid-arm region (10 cm distal to the axillary line) showed the best diagnostic performance (AUC 0.74; sensitivity 82.4%; specificity 51.9%; cutoff >11.4 mm), and four of the six points demonstrated good accuracy (AUC 0.73-0.74).ConclusionUltrasound using standardized anatomical points and defined cutoff values provides good discriminatory capacity for diagnosing upper extremity lipedema and represents an accessible and reproducible adjunct to clinical assessment.