An experienced doctor should be able to tell at a glance whether en/lipedemaa is present or not - provided he or she is familiar with this clinical picture. In principle, no special diagnosis of this disease is required. Further clarification always makes sense if other concomitant diseases need to be sought or ruled out (e.g. venous insufficiency, a rheumatic condition, arthrosis, etc.).

Visual diagnosis

Lipoedema has characteristic features, which is why a single glance is often enough to make a diagnosis. The first thing you notice is that the legs and/or arms appear too fat compared to the rest of the body (trunk). Lipoedema on the lower leg begins at the level of the ankles and usually affects the entire lower leg. The region below the ankles at the back of the foot (ankle ridge) and also the back of the foot remain unaffected. Increased fatty tissue is found on the front, inside and/or outside of the thigh. Classic fat deposits such as saddlebags or between the thighs appear even more pronounced, sometimes even grotesque. In some cases, the buttocks are involved, but this does not have to be the case.

Lipoedema is often also found on the upper arm as a circular accumulation of fat, i.e. the entire arm is affected. Hands and feet are never actually affected by en/lipedemaa, but it is possible that the vessels on the feet are not visible. The cause is then not en/lipedemaa, but a lymph congestion component (accompanying lymph congestion).

Self-test/"pinch test"

The skin on the arms and legs is generally very thin, so that the veins are visible on the back of the hand or foot and often also on the entire lower leg. A "pinch test" shows that there is no fatty tissue in this area. In the case of en/lipedemaa, there is significantly more to a lot of fat between the skin and the muscles. No veins are visible at all on the lower leg, and the skin fold between the fingers is very thick in the "pinch test" - in the worst case, no skin fold can be formed at all. The vessels on the back of the foot are normally always visible in the case of en/lipedemaa; they only disappear in the case of lymphoedema.

Ultrasound

Ultrasound is used in the diagnosis of en/lipedemaa to rule out venous insufficiency. This can be present as a concomitant disease without being visible on the leg. Only ultrasound can clarify this issue with certainty.

In certain cases, it also makes sense to use ultrasound to measure the thickness of fat in certain areas, e.g. to document a progression or for an expert opinion. Ultrasound can also distinguish whether the leg swelling is en/lipedemaa or lymphoedema. In the case of en/lipedemaa, "snowstorm-like" images of the tissue under the skin can be seen, whereas in the case of lymphoedema, the congestion of the lymph septa is visible.

These examinations are not normally necessary, but are only carried out for very specific issues.