Discuss causes of both unilateral and bilateral leg. Edema can also develop as a result of a blood clot in the deep veins of the lower leg called deep vein thrombosis dvt. Children who present with unilateral or bilateral swelling of the legs are often suspected of having a deep venous thrombosis. Treatment of bacterial skin and soft tissue infections. This ongoing project is the result of the hard work and dedication of medical students and faculty at the university of calgary. The patient had noticed this swelling since 3 days. Unilateral leg edema is a frequent clinical problem, usually reflecting underlying vascular disease. He also reported vague abdominal discomfort and tiredness. A 65 year old man described swelling in both legs, which had worsened over six weeks. Most unilateral lower limb swelling is the result of deep vein thrombosis or lymphatic disorders. Unusual presentation of nonhodgkin s bcell lymphoma. No fevers and reports she gets chills at times but doesnt feel well right now. Evaluation when evaluating a patient with pedal edema, it is important to distinguish between unilateral and bilateral disease.
A 25yearold female having asymptomatic edema of unilateral leg was provisionally diagnosed as a case of psoas abscess. The acute onset of unilateral leg oedema can point to a diagnosis of thrombophlebitis, especially with the presence of inflammation such as. 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. Venous thromboembolism diagnosis and treatment adult. 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. The arm swelling resolved spontaneously, but, a few months later, moderately painful leg swelling occurred. What are the causes of unilateral upper limb edema. Peripheral oedema is the presence of palpable swelling resulting from increased.
Oedema in angiooedema is mainly restricted to the face and lips, although any part of the body may be affected. Lymphatic massage, also called manual lymphatic drain. A common challenge for primary care physicians is to determine the cause and find an effective treatment for leg edema of unclear etiology. Right leg pain and swelling and redness and warmth 46 yo female with sudden onset right lower leg pains and chills.
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. A 9yearold girl presented with a 10day history of swelling of the left. Scrotal swelling can happen rapidly or slowly over time. Hypothesisthe causes and management of lower limb lymphedema in the western. Unilateral leg swelling is a common clinical presentation, with deep vein thrombosis dvt often the top differential. It can be seen at any age as already noted, and two thirds of cases are unilateral. 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. Edema is defined as a palpable swelling caused by an increase in interstitial fluid volume. However, not infrequently, a range of pathologies are instead diagnosed. Deep venous thrombosis dvt is a prominent cause of lower limb swelling. Keywords component, unilateral leg edema, nonhodgkins bcell lymphoma, inguinal lymphadenopathy 1. Other disease process, including heart failure, cirrhosis, acute renal failure, nephrotic syndrome, chronic venous insufficiency, and medication induced edema must first be considered. Its not just a dvt a case of intraoperative tourniquetinduced rhabdomyolysis pi chun cheng, md allen hoang, md gema naum, md t.
Edema exercises to improve drainage you will improve your lymph flow by doing a few exercises each day. Pdf unilateral leg swelling and hydronephrosis mohamad. Pittingdependent oedema will become sacral if bedbound. She had unilateral, right, lower limb oedema extending upto the knee and pitting in nature. 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. Umar zein tropical and infectious diseases clinic, medan, indonesia. An obscure cause of leg edema, nonhodgkins lymphoma.
This presentation is contrary to usual age and mode of presentation of nonhodgkins lymphoma. Unilateral leg swelling secondary to venous insufficiency. Examination of the lower limbs revealed pitting oedema bilaterally up to the groin, but no erythema, tenderness, or warmth. This may present with bilateral peripheral oedema but is often asymmetrical. Acute deep vein thrombo sis is associated with unilateral swelling, pain and at times erythema. Peripheral edema refers to swelling in your lower legs or hands, and it can have a variety of causes ranging from mild to serious. As a rare cause of unilateral leg swelling, extrinsic vein compression caused by intraperitoneal, retroperitoneal, or inguinal lesions has been noted. To open a pdf file you will need compatible software such as adobe reader. Hosaether odrinck pa the use of mri in the investigation of leg oedema. Acute unilateral leg swelling and pain after orthopedic surgery. 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. The skin of the left lower leg was pink and hot, and pitting oedema was noted. Pdf a 57yearold man with history of hypertension presented with 6 days history of left lower extremity swelling, pain and purple discoloration.
Unusual presentation of prostate cancer with generalized lymphadenopathy and unilateral leg edema. Unilateral leg lymphoedema may occur secondary to radiation, surgery, compression by a tumour or early filariasis infection. Approach to leg edema of unclear etiology american board. Unilateral leg swelling umar zein1, hadiki habib2 1 dr. Request pdf on jan 1, 2005, samer homsi and others published unilateral leg swelling. There was no history of fever, trauma, local foot infection, pain in the limb or difficulty in walking. Unilateral pedal edema suggests an obstructive process, such as venous thrombosis or cancer. While doing these exercises, wear your compression wraps or garment. These exercises are an important part of your home program. It tends to be unilateral and the extent, site and number of previous episodes will determine the degree of swelling. Evaluation of the swollen leg american society of podiatric.
Unilateral, localized bullous pemphigoid in a patient with chronic venous stasis connie r. Pdf an often missed etiology for unilateral painful. 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. Welcome to the eighth edition of the calgary black book. An often missed etiology for unilateral painful swollen leg. 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. This article provides clinically oriented recommendations for the management of leg edema in adults. These files will have pdf in brackets along with the filesize of the download.
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. Venous incompetence or deep vein thrombosis venous incompetence or a history of deep vein thrombosis can lead to impaired venous return. Unilateral upper limb edema refers to the swelling of the soft tissues of either the right or left arm or hand. The rest of the history and examination were unremarkable. What is the differential diagnosis of chronic leg edema in primary. The outpatient with unilateral leg swelling sciencedirect. Stay in the correct posture while doing these exercises. Zierlerrehabilitation of the patient with peripheral vascular disease of the lower extremity. Lower extremity pain clinical guidelines for workup.
Pdf unilateral leg swelling and hydronephrosis researchgate. Hypothesis the causes and management of lower limb lymphedema in the western population are different from those in the developing world. Practical approach to lower extremity edema anmed health. Leg edema family medicine slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. If you continue browsing the site, you agree to the use of cookies on this website. The patient was otherwise systemically well with normal heart sounds and a clear chest examination. Disease childhood the swollen leg and primary lymphoedema. Unilateral swelling from compression or compromise of venous or lymphatic drainage can result from dvt, venous insufficiency, venous obstruction by tumor e. Unilateral leg swelling and redness digital nomad physician. She reported discomfort and pain in the calf and upper thigh. In this case, the edema is mostly limited to the feet or ankles and usually affects only one side the left or right.
Differential diagnosis, investigation, and current treatment of lower. Pdf most of the documents on the racgp website are in portable document format pdf. Hxcontinue readingunilateral leg swelling and redness. Often, its due to factors you can change or a situation that. We present two cases of a unilateral leg swelling of unusual aetiology.
We are proud that healthcare practitioners and trainees across canada find the black book to be a useful tool. Assessment of peripheral oedema differentials bmj best practice. Unilateral leg swelling caused by common femoral vein. Unilateral leg swelling in an adolescent girl rheumatology oxford. Unilateral swelling of the leg andor foot or along a vein ppt. 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. Find, read and cite all the research you need on researchgate. M are peripheral lymphatics damaged by high pressure manual massage. A noncardiac cause of bilateral leg swelling the bmj. Bilateral pedal edema, which is more common in older adults, is. A 9yearold girl presented with a 10day history of swelling of the left leg that occurred spontaneously and gradually increased in size by 33%. We therefore suggest that diffuse soft tissue edema, with in. 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. One of the main causes of painful scrotal swelling is testicular torsion.
The incidence of deep venous thrombosis in children is low and lymphoedema may be a more appropriate diagnosis. Causes and treatment for fluid leaking from legs with blisters. Unilateral swelling, particularly of the calf, suggests a dvt. The diagnosis can be narrowed by categorizing the edema according to its duration, distribution unilateral or bilateral and accompanying symptoms.
The rest of the findings on skin examination were unremarkable. Later, she turned out to be a case of nonhodgkins lymphoma. This article describes an uncommon cause of this presentation, malignant lymphoma, in ten cases. Idiopathic pedal edema need not to be treated with diuretics.
Unilateral leg edema is generally due to a local cause such as deep vein thrombosis, venous insufficiency, or lymphedema. Based on presented evidence, it is premature to make the initial diagnosis of venous insufficiency without further. Unilateral, localized bullous pemphigoid in a patient with. She first noticed these symptoms 4 years ago after giving birth to her second child. Diagnosis and management american family physician. In three of these patients, the diagnosis of lymphoma was overlooked during the initial presentation, and appropriate therapy not given at that time. Atypical lymphoedema was suspected and a lymphangiogram was performed. Differential diagnosis, investigation, and current. Unilateral swelling of the leg andor foot or along a vein in the leg.
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. Pain or tenderness in the leg which may be felt only when standing or walking. See general principles of the treatment of edema in adults and causes and treatment of refractory edema in adults. This is an injury or an event that causes a testicle in the. If it occurs in the upper extremity, it is usually due to problems with drainage of the blood or lymph from the arm. Lymphoedema was suspected and lymphatic obstruction confirmed by lymphoscintigraphy, no obvious lymphatic vessels being identified. Robert vu, md, facp tourniquet use as a result of an equipment malfunction in the or.
681 159 91 256 566 168 62 178 342 584 252 341 987 1467 534 366 911 1289 897 169 404 1346 1408 488 848 653 70 771 831 109 1347 990 351 731 56 1098 61 437 608 647