Bruno Agostino, Cilluffo Matteo
Private Practice, Rome, Italy.
Plastic and Aesthetic surgery, University of Rome La Sapienza, Rome, Italy.
Aesthetic Plast Surg. 2025 Sep 12. doi: 10.1007/s00266-025-05192-1.
Lipedema is a chronic disorder of adipose tissue that predominantly affects women and is frequently misdiagnosed as obesity or lymphedema. Traditionally associated with the lower extremities, lipedema can also involve the abdominal region, although there are currently no established diagnostic criteria for abdominal lipedema. This study aims to propose a diagnostic algorithm for abdominal lipedema based on clinical features, macroscopic observations, and ultrasound findings.
This retrospective study analyzed data from 327 patients treated between March 2018 and March 2024 for lipedema, including those with abdominal involvement. Clinical evaluations, ultrasound imaging, and surgical outcomes were examined to assess the prevalence and characteristics of abdominal lipedema. Patients were classified based on lipedema severity, and criteria for abdominal lipedema diagnosis were established through clinical and imaging data.
The study identified that abdominal involvement increases with the severity of lipedema, with 31% of patients with stage II lipedema and 70% of those with stage III lipedema exhibiting abdominal manifestations. The proposed diagnostic algorithm includes maximum, major, and minor criteria, such as symmetrical fat deposition, pain, and non-responsiveness to diet and exercise. Specific threshold values for each category were defined to establish the diagnosis. The findings highlight the existence of both ascending (from legs to abdomen) and descending (from arms to abdomen) centripetal progression patterns, challenging traditional notions that limit lipedema to the extremities CONCLUSION: Abdominal lipedema is a significant and underrecognized manifestation of the condition, requiring specific diagnostic criteria to ensure accurate diagnosis and appropriate treatment. The study proposes a diagnostic framework based on clinical and imaging features that can improve the recognition and management of abdominal lipedema. Multidisciplinary treatment approaches, including both conservative measures and surgical interventions such as abdominoplasty and liposuction, are recommended to improve patient outcomes.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
脂肪性水肿是一种主要影响女性的慢性脂肪组织疾病，常被误诊为肥胖或淋巴水肿。传统上脂肪性水肿与下肢有关，也可累及腹部区域，尽管目前尚无腹部脂肪性水肿的确切诊断标准。本研究旨在基于临床特征、宏观观察和超声检查结果，提出一种腹部脂肪性水肿的诊断算法。
这项回顾性研究分析了2018年3月至2024年3月间接受脂肪性水肿治疗的327例患者的数据，包括有腹部受累的患者。对临床评估、超声成像和手术结果进行检查，以评估腹部脂肪性水肿的患病率和特征。根据脂肪性水肿的严重程度对患者进行分类，并通过临床和影像数据建立腹部脂肪性水肿的诊断标准。
研究发现，腹部受累情况随脂肪性水肿严重程度的增加而增加，II期脂肪性水肿患者中有31%、III期脂肪性水肿患者中有70%出现腹部表现。所提出的诊断算法包括主要、次要和微小标准，如对称性脂肪沉积、疼痛以及对饮食和运动无反应。为每个类别定义了特定的阈值以确立诊断。研究结果突出了向心性进展模式的存在，既有从腿部到腹部的上行模式，也有从手臂到腹部的下行模式，这对将脂肪性水肿局限于四肢的传统观念提出了挑战。结论：腹部脂肪性水肿是该疾病的一种重要但未得到充分认识的表现形式，需要特定的诊断标准以确保准确诊断和恰当治疗。该研究提出了一个基于临床和影像特征的诊断框架，可以提高对腹部脂肪性水肿的识别和管理。建议采用多学科治疗方法，包括保守措施以及腹部整形术和抽脂术等手术干预，以改善患者预后。
证据级别IV：本刊要求作者为每篇文章指定证据级别。有关这些循证医学评级的完整描述，请参阅目录或作者在线指南www.springer.com/00266 。
