Differential diagnosis, investigation, and current treatment of lower. She first noticed these symptoms 4 years ago after giving birth to her second child. It can be seen at any age as already noted, and two thirds of cases are unilateral. Umar zein tropical and infectious diseases clinic, medan, indonesia.
Edema exercises to improve drainage you will improve your lymph flow by doing a few exercises each day. Differential diagnosis of the swollen leg mainly unilateral dvt pts cvi angiodysplasias cellulitis, arthritis aca baker cyst lymphedema mainly bilateral lipedema cyclic idiopathic cardiac, renal, hepatic, dysproteinemic drugs. Diagnosis and management american family physician. Unilateral pedal edema suggests an obstructive process, such as venous thrombosis or cancer. This presentation is contrary to usual age and mode of presentation of nonhodgkins lymphoma. Based on presented evidence, it is premature to make the initial diagnosis of venous insufficiency without further. A noncardiac cause of bilateral leg swelling the bmj. As a rare cause of unilateral leg swelling, extrinsic vein compression caused by intraperitoneal, retroperitoneal, or inguinal lesions has been noted. What is the differential diagnosis of chronic leg edema in primary. The diagnosis can be narrowed by categorizing the edema according to its duration, distribution unilateral or bilateral and accompanying symptoms.
No fevers and reports she gets chills at times but doesnt feel well right now. Atypical lymphoedema was suspected and a lymphangiogram was performed. The patient had noticed this swelling since 3 days. An obscure cause of leg edema, nonhodgkins lymphoma. A r edema june 30, 2011 may 23, 2012 causes of fluid leaking out of legs, fluid leaking from legs, treatment for fluid leaking from legs 10 comments edema is a condition wherein there is an abnormal collection of liquid substances beneath the skin and cavities of the body. However, not infrequently, a range of pathologies are instead diagnosed.
Evaluation when evaluating a patient with pedal edema, it is important to distinguish between unilateral and bilateral disease. Idiopathic pedal edema need not to be treated with diuretics. Unilateral leg edema is a frequent clinical problem, usually reflecting underlying vascular disease. Unilateral lower extremity lymphoedema has been reported as a rare initial presentation for lymphoma, mostly in women, usually without bsymptoms, and often with inguinal lymphadenopathies or abdominal masses. The rest of the findings on skin examination were unremarkable. Unilateral upper limb edema refers to the swelling of the soft tissues of either the right or left arm or hand. Lower extremity pain clinical guidelines for workup. Welcome to the eighth edition of the calgary black book. Unilateral swelling of the leg andor foot or along a vein ppt. An often missed etiology for unilateral painful swollen leg.
Its not just a dvt a case of intraoperative tourniquetinduced rhabdomyolysis pi chun cheng, md allen hoang, md gema naum, md t. Find, read and cite all the research you need on researchgate. We present two cases of a unilateral leg swelling of unusual aetiology. Unilateral leg swelling in an adolescent girl rheumatology oxford. Peripheral oedema is the presence of palpable swelling resulting from increased. Bilateral pedal edema, which is more common in older adults, is. Hxcontinue readingunilateral leg swelling and redness. Unilateral leg swelling secondary to venous insufficiency margaret clarke tracci and julie armatas presentation a 33yearold woman with no past medical history presents with pain, swelling, and heaviness of her left leg. Unilateral leg edema is generally due to a local cause such as deep vein thrombosis, venous insufficiency, or lymphedema.
Pdf a 57yearold man with history of hypertension presented with 6 days history of left lower extremity swelling, pain and purple discoloration. The patient was otherwise systemically well with normal heart sounds and a clear chest examination. Request pdf on jan 1, 2005, samer homsi and others published unilateral leg swelling. If you continue browsing the site, you agree to the use of cookies on this website. Differential diagnosis, investigation, and current. She reported discomfort and pain in the calf and upper thigh. Hosaether odrinck pa the use of mri in the investigation of leg oedema. The general principles of the treatment of edema in adults, including the use of diuretics to remove the excess fluid, the treatment of refractory edema, and the approach to edema in children, are discussed separately. Nonhodgkins bcell lymphoma should be considered in the differential diagnosis in patients with unilateral leg edema when the swelling is chronic and deep venous thrombosis is promptly excluded. There was no history of fever, trauma, local foot infection, pain in the limb or difficulty in walking. Stay in the correct posture while doing these exercises. One of the main causes of painful scrotal swelling is testicular torsion. The arm swelling resolved spontaneously, but, a few months later, moderately painful leg swelling occurred. Treatment of bacterial skin and soft tissue infections.
He also reported vague abdominal discomfort and tiredness. In three of these patients, the diagnosis of lymphoma was overlooked during the initial presentation, and appropriate therapy not given at that time. Venous thromboembolism diagnosis and treatment adult. She had unilateral, right, lower limb oedema extending upto the knee and pitting in nature. Unilateral swelling from compression or compromise of venous or lymphatic drainage can result from dvt, venous insufficiency, venous obstruction by tumor e. It tends to be unilateral and the extent, site and number of previous episodes will determine the degree of swelling. Approach to leg edema of unclear etiology american board. Acute deep vein thrombo sis is associated with unilateral swelling, pain and at times erythema. Discuss causes of both unilateral and bilateral leg. Peripheral edema refers to swelling in your lower legs or hands, and it can have a variety of causes ranging from mild to serious. Examine the joints for swelling and range of motion evaluate range of motion to all upper and lower extremities including bilateral shoulders, elbows, wrists and fingers, hips, knees, ankles, and toes.
To open a pdf file you will need compatible software such as adobe reader. The outpatient with unilateral leg swelling sciencedirect. This may present with bilateral peripheral oedema but is often asymmetrical. Right leg pain and swelling and redness and warmth 46 yo female with sudden onset right lower leg pains and chills. Unilateral swelling of the leg andor foot or along a vein in the leg. Deep venous thrombosis dvt is a prominent cause of lower limb swelling. Scrotal swelling can happen rapidly or slowly over time. Leg edema family medicine slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Unilateral, localized bullous pemphigoid in a patient with chronic venous stasis connie r. Unilateral leg swelling umar zein1, hadiki habib2 1 dr.
Zierlerrehabilitation of the patient with peripheral vascular disease of the lower extremity. Disease childhood the swollen leg and primary lymphoedema. Often, its due to factors you can change or a situation that. The rest of the history and examination were unremarkable. Unilateral swelling, particularly of the calf, suggests a dvt. In this case, the edema is mostly limited to the feet or ankles and usually affects only one side the left or right. Children who present with unilateral or bilateral swelling of the legs are often suspected of having a deep venous thrombosis. The incidence of deep venous thrombosis in children is low and lymphoedema may be a more appropriate diagnosis. The most common cause of leg swelling is edema, but all or part of a limb may expand due to an increase in any tissue component muscle, fat, blood, etc. Unilateral leg swelling is a common clinical presentation, with deep vein thrombosis dvt often the top differential. This ongoing project is the result of the hard work and dedication of medical students and faculty at the university of calgary. Objective to look at the differential diagnosis, methods of investigation, and available treatments for lower limb lymphedema in the west. Brawny, nonpitting skin with edema characterizes lymphedema, which can present in one or both lower extremities.
Unilateral, localized bullous pemphigoid in a patient with. If it occurs in the upper extremity, it is usually due to problems with drainage of the blood or lymph from the arm. Unusual presentation of prostate cancer with generalized lymphadenopathy and unilateral leg edema. We therefore suggest that diffuse soft tissue edema, with in. These files will have pdf in brackets along with the filesize of the download. Unusual presentation of nonhodgkin s bcell lymphoma. A 9yearold girl presented with a 10day history of swelling of the left leg that occurred spontaneously and gradually increased in size by 33%. Acute unilateral limb swelling is a common clinical problem that has a relatively wide differential diagnosis both by clinical and imaging studies, nevertheless, the diagnostic list may include conditions that have quite different treatment plans, this mandates early establishment of the correct diagnosis. This article provides clinically oriented recommendations for the management of leg edema in adults. Hypothesisthe causes and management of lower limb lymphedema in the western. This is an injury or an event that causes a testicle in the. A common challenge for primary care physicians is to determine the cause and find an effective treatment for leg edema of unclear etiology. Other disease process, including heart failure, cirrhosis, acute renal failure, nephrotic syndrome, chronic venous insufficiency, and medication induced edema must first be considered. Pdf unilateral leg swelling and hydronephrosis researchgate.
These exercises are an important part of your home program. What are the causes of unilateral upper limb edema. We are proud that healthcare practitioners and trainees across canada find the black book to be a useful tool. The skin of the left lower leg was pink and hot, and pitting oedema was noted. Pittingdependent oedema will become sacral if bedbound. Unilateral leg swelling secondary to venous insufficiency. Later, she turned out to be a case of nonhodgkins lymphoma. Edema is defined as a palpable swelling caused by an increase in interstitial fluid volume.
Practical approach to lower extremity edema anmed health. Robert vu, md, facp tourniquet use as a result of an equipment malfunction in the or. While doing these exercises, wear your compression wraps or garment. Patients who have a primary care provider pcp can be referred to the swollen leg clinic slc where a midlevel provider will perform clinical risk scoring. Acute unilateral leg swelling and pain after orthopedic surgery.
Examination of the lower limbs revealed pitting oedema bilaterally up to the groin, but no erythema, tenderness, or warmth. Lymphoedema was suspected and lymphatic obstruction confirmed by lymphoscintigraphy, no obvious lymphatic vessels being identified. Optimising nicotine replacement therapy in clinical practice. M are peripheral lymphatics damaged by high pressure manual massage. Keywords component, unilateral leg edema, nonhodgkins bcell lymphoma, inguinal lymphadenopathy 1. Lymphatic massage, also called manual lymphatic drain. The acute onset of unilateral leg oedema can point to a diagnosis of thrombophlebitis, especially with the presence of inflammation such as. This article describes an uncommon cause of this presentation, malignant lymphoma, in ten cases. A 65 year old man described swelling in both legs, which had worsened over six weeks.
Evaluation of the swollen leg american society of podiatric. A 25yearold female having asymptomatic edema of unilateral leg was provisionally diagnosed as a case of psoas abscess. We were unable to find existing practice guidelines that address this problem in a comprehensive manner. See general principles of the treatment of edema in adults and causes and treatment of refractory edema in adults. Venous incompetence or deep vein thrombosis venous incompetence or a history of deep vein thrombosis can lead to impaired venous return. Pdf an often missed etiology for unilateral painful. Pdf unilateral leg swelling and hydronephrosis mohamad. Unilateral leg swelling and redness digital nomad physician. Most unilateral lower limb swelling is the result of deep vein thrombosis or lymphatic disorders.
Assessment of peripheral oedema differentials bmj best practice. Oedema in angiooedema is mainly restricted to the face and lips, although any part of the body may be affected. Uw health swollen leg clinic v ascular surgery providers at the uw health west clinic have extended hours to offer sameday service for patients with new leg swelling. Unilateral leg swelling caused by common femoral vein. Unilateral leg lymphoedema may occur secondary to radiation, surgery, compression by a tumour or early filariasis infection. Pdf most of the documents on the racgp website are in portable document format pdf. Hypothesis the causes and management of lower limb lymphedema in the western population are different from those in the developing world. Leg edema is a common problem with a wide range of possible causes and is the result of an imbalance in the filtration system between the capillary and interstitial spaces.