A 73yearold man with a history of follicular lymphoma ten years ago with complete remission presented to the emergency room with a large unilateral left leg swelling as the only symptom. Causes of leg oedema that require prompt treatment must be identified, e. Doctors give trusted, helpful answers on causes, diagnosis, symptoms, treatment, and more. While doing these exercises, wear your compression wraps or garment. This article describes an uncommon cause of this presentation, malignant lymphoma, in ten cases.
Leg swelling must never be assumed to be due to peripheral oedema. It is attributed to lymphatic or venous obstruction in the lower limb, apart from local inflammatory or traumatic causes. Legbo introduction unilateral limb enlargement ule is a challenging diagnostic and management problem. 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.
Approach to leg edema of unclear etiology american board of. Leg swelling caused by the retention of fluid in leg tissues is known as peripheral edema. Clinical differential diagnosis of the swollen leg. Common and important causes of unilateral leg swelling for doctors and medical students this page is currently being written and will be available soon. There was no circulatory compromise of the left leg, and he. Chronic leg edema is defined as palpable swelling caused by an increase in interstitial fluid volume lasting at least 72 hours. It happens when the tissues or blood vessels in your legs hold more fluid than they should. Leg swelling isnt always a sign of a heart or circulation problem. Jul 14, 2016 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. This can happen if you simply spend a long day on your feet or sit for too long.
Disease childhood the swollen leg and primary lymphoedema. Differential diagnosis, investigation, and current. Follicular lymphoma recurrence presenting as unilateral. Edema can also develop as a result of a blood clot in the deep veins of the lower leg called deep vein thrombosis dvt. If it occurs in the upper extremity, it is usually due to problems with drainage of the blood or lymph from the arm. Practical approach to lower extremity edema anmed health.
To be updated when it is complete please like us on facebook, follow us on twitter or subscribe on youtu. It can also result from inflammation of soft tissue. An 8monthold boy presented with a weeks history of left lower limb swelling. These exercises are an important part of your home program. While it is common to have swollen lower extremities postpartum as fluid shifts occur after delivery, this is usually bilateral. Unilateral means that the swelling appears only on one leg, while bilateral means that both legs are swollen.
Dengue is a common arthropodborne viral infection in sri lanka which is spread by the mosquitos of the genus aedes. He was apyrexic, well and developmentally age appropriate. Bilateral edema can be due to a local cause or systemic disease, such as heart failure or kidney disease. It is called edema and is basically the collection of fluids or water. Unilateral leg swelling secondary to venous insufficiency.
The incidence of deep venous thrombosis in children is low and lymphoedema may be a more appropriate diagnosis. Unilateral leg swelling and redness digital nomad physician. However, bilateral swelling from systemic causes may be much more obvious on one side than the other and therefore can appear to be unilateral swelling. The weakened pumping capacity of the heart causes blood pooling in the legs and water retention by the kidneys. Edema is defined as a palpable swelling caused by an increase in interstitial fluid volume.
Swelling in the legs is caused by a buildup of fluid called edema. She had unilateral, right, lower limb oedema extending upto the knee and pitting in nature. Objectivewe present two cases of a unilateral leg swelling of unusual aetiology as a reminder to the physician to consider causes of unilateral leg swelling other than deep vein thrombosis, lymphoe. Unilateral leg lymphoedema may occur secondary to radiation, surgery, compression by a tumour or early filariasis infection. The key to diagnosis and management is a thorough history and examination to determine the primary pathology, which includes inflammation, infection or. Causes of a swollen ankle with no pain healthfully. No fevers and reports she gets chills at times but doesnt feel well right now. An obscure cause of leg edema, nonhodgkins lymphoma. Case records of the massachusetts general hospital from the new england journal of medicine case 202012 a 77yearold man with leg edema, hematuria, and acute renal failure. The acute onset of unilateral leg oedema can point to a diagnosis of thrombophlebitis, especially with the presence of inflammation such as increased warmth, tenderness and erythema.
As a rare cause of unilateral leg swelling, extrinsic vein compression caused by intraperitoneal, retroperitoneal, or inguinal lesions has been noted. Within 2 weeks, the swelling improved dramatically. Find powerpoint presentations and slides using the power of, find free presentations research about unilateral leg swelling ppt. Differential diagnosis of neck swellings very important to differentiate between both types, because each has a different management both are deep to the fascia, so their consistency is similar firm diagnosed by us. Deep vein obstruction and leg swelling caused by femoral. If the swelling is unilateral andor accompanied by pain, would recommend seeking evaluation to confirm not a deep vein. Unilateral definition of unilateral by merriamwebster. Pdf unilateral leg swelling and hydronephrosis mohamad. Check the full list of possible causes and conditions now. This list does not constitute medical advice and may not accurately represent what you have. What are the causes of unilateral upper limb edema. In addition to the lack of hip dominant exercises on offer, there were virtually no hip dominant unilateral leg options. Examination of the lower limbs revealed pitting oedema bilaterally up to the groin, but no erythema, tenderness, or warmth. The causes of unilateral leg swelling are numerous, and many previous articles have addressed this topic.
The patient had noticed this swelling since 3 days. Bedside pointofcare ultrasound pocus revealed left moderate hydronephrosis. The evaluation of a child presenting with localized swelling requires a thorough history and physical examination. Feb 22, 2016 unilateral leg swelling is more often due to local causes eg, deep vein thrombosis or cellulitis. Hxcontinue readingunilateral leg swelling and redness. You may have noticed new swelling in any part of one or both legs, this includes feet and ankles. Swelling in one leg during pregnancy doctor answers. The buildup of fluid usually isnt painful, unless its.
Swelling of the legs may be either unilateral or bilateral. Basically the only single leg exercises used during the 19601990 era were the lunge and bench steps, which in my opinion not fully unilateral movements. Magnetic resonance venography of the lower extremity and pelvis should be obtained in patients with unilateral left leg swelling and negative results on duplex ultrasonography if there is high. A young female presenting with unilateral sacroiliitis. Unilateral lower limb oedema in pregnancy is a nonphysiological phenomenon. It happens when the tissues in your legs get irritated and swollen. Carcinoma of prostate in males and lymphomas and pelvic tumours in females are commonly responsible. Objective to look at the differential diagnosis, methods of investigation, and available treatments for lower limb lymphedema in the west. Atypical lymphoedema was suspected and a lymphangiogram was performed.
Children who present with unilateral or bilateral swelling of the legs are often suspected of having a deep venous thrombosis. Differential diagnosis for unilateral leg swelling. View and download powerpoint presentations on unilateral leg swelling ppt. Diagnosis and management american family physician. A 65 year old man described swelling in both legs, which had worsened over six weeks.
In some cases of bilateral leg swelling, one leg might appear bigger than the other one, thus looking like unilateral leg swelling. An often missed etiology for unilateral painful swollen leg. Other disease process, including heart failure, cirrhosis, acute renal failure, nephrotic syndrome, chronic venous insufficiency, and medication induced edema must first be considered. Find leg swelling stock images in hd and millions of other royalty free stock photos, illustrations and vectors in the shutterstock collection. 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. Find possible causes of symptoms in children and adults. Unilateral upper limb edema refers to the swelling of the soft tissues of either the right or left arm or hand. In three of these patients, the diagnosis of lymphoma was overlooked during the initial presentation. In three of these patients, the diagnosis of lymphoma was.
Differential diagnosis of the swollen leg mainly unilateral dvt. There are a number of causes of lower extremity edema. He was discharged from the hospital with complete improvement of the leg swelling, and has remained free from recurrence 1 year after surgery. A variety of clinical conditions are associated with the development of edema, including heart failure, cirrhosis, and the nephrotic syndrome, as well as local conditions. Pdf edema is defined as a palpable swelling caused by an increase in. Learn about the possible medical conditions and medications that can cause.
Obstructive sleep apnea may cause bilateral leg edema even in the absence. If youve had foot, ankle, andor leg swelling for a while, this guide may still be useful, but the focus will be on new symptoms. Ninetyfive percent of unilateral lymphedema involves obstruction of lymphatics due to infection, postoperative lymphatic disruption and malignancy. She first noticed these symptoms 4 years ago after giving birth to her second child. Leg edema is a common problem with a wide range of possible causes and is the result of an imbalance in. Differential diagnosis for unilateral leg swelling oxford. Sometimes, it is actually very hard to tell one from the other. Balakirski g, cacchi c, knuechelclarke r, meg ahed m. Most unilateral lower limb swelling is the result of deep vein thrombosis or lymphatic disorders. Exercise, elevation of the limbs, compression, manual lymph drainage. Unilateral leg edema is a frequent clinical problem, usually reflecting underlying vascular disease.
It can be caused by a problem with the venous circulation system, the lymphatic system or the kidneys. When last seen in may 2012, she was very well with no discernible leg swelling and good transplant function creatinine 156. Deep vein thrombosis remains one of the more common and clinically significant causes, particularly in view of the associated risk of pulmonary embolization. There is little guidance for the utility of bnp levels in identifying hf in patients that present primarily with leg edema and without dyspnea. Unilateral leg swelling is a common clinical presentation, with deep vein thrombosis dvt often the top differential. Follicular lymphoma recurrence presenting as unilateral leg. Acute unilateral limb swelling is a common clinical problem that has a relatively wide differential.
A common challenge for primary care physicians is to determine the cause and find an effective treatment for leg edema of unclear etiology. If you continue browsing the site, you agree to the use of cookies on this website. Isolated lymphedema of the leg is often idiopathic in nature. Hypothesis the causes and management of lower limb lymphedema in the western population are different from those in the developing world. There was no history of fever, trauma, local foot infection, pain in the limb or difficulty in walking. What is the differential diagnosis of chronic leg edema in. A noncardiac cause of bilateral leg swelling the bmj. Mar 25, 2020 many factors varying greatly in severity can cause leg swelling. Approach to leg edema of unclear etiology american board. Persistent ankle swelling without pain is a common symptom among people living with moderate to severe heart failure. Unilateral leg swelling caused by common femoral vein. Table 1 lists the most common causes of leg oedema that present to gps today. Unilateral leg swelling is more often due to local causes eg, deep vein thrombosis or cellulitis.
Right leg pain and swelling and redness and warmth 46 yo female with sudden onset right lower leg pains and chills. Journal of medical case reports a young female presenting with unilateral sacroiliitis following dengue virus infection. Unilateral leg swelling in an infant adc education. A more insidious development or chronic duration of unilateral leg oedema can. Jul 19, 2015 right leg pain and swelling and redness and warmth 46 yo female with sudden onset right lower leg pains and chills. Presentation of lymphoma, as leg edema, is uncommon. Feb 26, 2017 leg edema family medicine slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Unilateral lower extremity swelling as a rare presentation. The arm swelling resolved spontaneously, but, a few months later, moderately painful leg swelling occurred. A tentative diagnosis of unilateral lymphoedema due to a mammalian target of rapamycin mtor inhibitor was made and sirolimus was withdrawn. Request pdf on jan 1, 2005, samer homsi and others published unilateral leg swelling. We were unable to find existing practice guidelines that address this problem in a comprehensive manner.
A ct of the abdomen showed a bulky soft tissue mass in the region of. Jan 12, 2019 4 possible unilateral upper leg swelling causes. Case 202012 a 77yearold man with leg edema, hematuria. People with stasis dermatitis usually experience swollen legs. Challenges in developing unilateral leg exercise options. We therefore suggest that diffuse soft tissue edema, with in. Brawny, nonpitting skin with edema characterizes lymphedema, which can present in one or both lower extremities. Foot, leg, and ankle swelling is also known as peripheral edema, which refers to an accumulation of fluid in these parts of the body. Jan, 2014 unilateral lower extremity oedema can be classified into acute or chronic duration. However, studies have demonstrated that congestion may precede symptoms of hf by 7 to 10 days and that rising bnp levels in patients with chf are at higher risks for decompensation.
Jul 15, 20 magnetic resonance venography of the lower extremity and pelvis should be obtained in patients with unilateral left leg swelling and negative results on duplex ultrasonography if there is high. Unilateral numbness, stiffness, and swelling neurology. Edema exercises to improve drainage you will improve your lymph flow by doing a few exercises each day. Doppler ultrasonography ruled out deep vein thrombosis. Find detailed information on stasis dermatitis and ulcers, including causes, symptoms, treatment, and prevention. Bilateral swelling is more commonly due to systemic conditions whereas unilateral swelling more often represents local pathology. In this case, the edema is mostly limited to the feet or ankles and usually affects only one side the left or right.
Thousands of new, highquality pictures added every day. However, not infrequently, a range of pathologies are instead diagnosed. 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 diagnosis can be narrowed by categorizing the edema according to its duration, distribution unilateral or. Stay in the correct posture while doing these exercises. This article provides clinically oriented recommendations for the management of leg edema in adults. Please see a sports medicine or musculoskeletal specialist. For full access to this pdf, sign in to an existing account, or.
Have you noticed any unusual leg swelling recently. He also reported vague abdominal discomfort and tiredness. We will try to help you figure out the reason why you might be experiencing leg pain and swelling. Lymphoedema was suspected and lymphatic obstruction confirmed by lymphoscintigraphy, no obvious lymphatic vessels being identified. It didnt help and the entire right leg up till my knee soon went numb. Summary unilateral lower extremity edema below the knee commonly results from deep venous thrombosis, ve. Edema is defined as a palpable swelling produced by expansion of the interstitial fluid volume. Pdf an often missed etiology for unilateral painful. 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. The list below shows results from the use of our quiz by buoy users who experienced unilateral upper leg swelling. Unilateral leg edema is generally due to a local cause such as deep vein thrombosis, venous insufficiency, or lymphedema. Treatment options are often complex and are dependent upon accurately determining the correct aetiology for each individual case.