Resource Overutilization in the Diagnosis of Lymphedema Praecox
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In brief
In brief
This 13-year retrospective study of 49 adolescent patients demonstrates significant overutilization of diagnostic imaging in lymphedema praecox, with costs ranging from $335 for X-rays to $6006 for MRI. Authors recommend limiting workup to Doppler ultrasound to exclude secondary causes in adolescent females with clinical findings consistent with primary lymphedema.
Written by the GCMD Library team from the article.
Purpose
Primary lymphedema presenting in adolescence is known as lymphedema praecox. Older children presenting with leg swelling are often subjected to a myriad of diagnostic tests. The purpose of this study is to review a large-cohort of patients with lymphedema praecox to determine the fiscal impact of diagnostic testing on these patients.
Methods
A 13-year review was performed of patients with lymphedema praecox. Information was obtained on demographic parameters, diagnostic studies performed, and clinical outcomes.
Results
Forty-nine patients were identified. The median age was 14 (range: 7–21) years. Participants were predominantly female (n = 40, 81.6%). 19 patients had bilateral disease and 30 had unilateral disease. The diagnosis was made on clinical exam only in 14 patients. 35 patients had imaging which consisted of plain X rays, Doppler ultrasound (DUS), lymphoscintigraphy (LSG) or MRI as the sole imaging study (n = 28) or in combination with others (n = 7). The charges for plain X-rays, DUS, LSG, and MRI with contrast were $335, $1715, $1269, and $6006 respectively.
Conclusion
We believe that in the adolescent female with physical findings consistent with lymphedema praecox, diagnostic imaging should be limited to a Doppler ultrasound to rule out a secondary cause of the swelling.
Level of Evidence
IV
Type of Evidence
Case series with no comparison group.