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Differential diagnosis
Venous oedema can sometimes be difficult to differentiate from lymphoedema, especially if it is caused by the iliac vein compression syndrome, when there is often little in the way of superficial venous engorgement.  The presence of dilated collateral veins or varicose veins normally suggests venous oedema, as does a past history of deep vein thrombosis. Other causes of bilateral limb oedema include cardiac disease, nephrotic syndrome, hypoproteinaemia, fluid overload during intravenous therapy, and chronic liver disease. These disorders can be excluded by a careful physical examination and appropriate blood tests. Klippel Trenauney and Parks-Weber syndromes also cause limb enlargement: the former is occasionally associated with lymphoedema. True gigantism (Robertson's giant limb) also occurs, when all the tissues (muscles and bones) are hypertrophied. Abnormal fat deposition (lipoidosis or lipodystrophy) can be excluded by the fact that fat does not pit. Periodic oedema experienced by women before menstruation is often difficult to separate from lymphoedema. Rapidly growing soft tissue sarcomata rarely cause diagnostic problems. Before making a diagnosis of one of these rare conditions, for which venography, CT scanning, and arteriography may be required, it is often simpler to exclude lymphoedema by isotope lymphography.
Investigations
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