swollen_leg
Table of Contents
the patient with swollen leg(s)
see also:
introduction
- the patient with swollen leg or legs, or peripheral oedema is a common presentation to the ED
- it is usual to assess whether the swelling is bilateral or not and if there is pitting oedema
- non-pitting oedema suggests lipoedema, obesity, myxoedema or advanced fibrotic forms of lymphedema / lymphoedema
- most cases are NOT painful but deep venous thrombosis (DVT), cellulitis, traumatic causes, compartment syndrome, lipoedema and reflex sympathetic dystrophy (RSD) / complex regional pain syndrome / causalgia ARE painful while venous insufficiency of the leg is often associated with low grade ache
- venous oedema is more likely than lymphoedema to improve overnight with elevation of legs
- a warty texture (hyperkeratosis) with papillomatosis and brawny induration are characteristic of chronic lymphoedema
- brown haemosiderin deposits on the lower legs and ankles are consistent with venous insufficiency
- increased sweating suggests acute phases of reflex sympathetic dystrophy (RSD) / complex regional pain syndrome / causalgia
aetiology of the unilateral swollen leg
- trauma - haematoma
- compartment syndrome
- ruptured medial head of gastrocnemius
- joint effusion
- ruptured Baker's cyst
- chronic causes:
-
- tumour
- radiotherapy
- surgery
- post-infection
- idiopathic
- pressure on iliac vein:
- unilateral pelvic mass such as ovarian tumours, lymphoma
aetiology of bilateral swollen legs
- raised central venous pressures:
- due to sodium and water overload / retention with increased extracellular fluid volume (ECFV)
- iatrogenic
- due to cardiac failure
- venous insufficiency of the leg +/- exacerbated by:
- prolonged dependency
- glitazone oral hypoglycaemic agents
- deep venous thrombosis (DVT) if either:
- extensive and involving the IVC causing bilateral oedema
- bilateral DVT's
- pelvic mass causing pressure on iliac veins
- pregnancy
-
- idiopathic
- radiotherapy
- post-surgical
- post-infective
- hypoalbuminaemia
- hypothyroidism - myxoedema
swollen_leg.txt · Last modified: 2023/03/22 22:33 by gary1