This presentation is contrary to usual age and mode of presentation of nonhodgkins lymphoma. Unilateral swelling of the leg andor foot or along a vein in the leg. A common challenge for primary care physicians is to determine the cause and find an effective treatment for leg edema of unclear etiology. Leg swelling can result either from fluid buildup fluid retention or from inflammation in injured or diseased tissues or joints. 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. Approach to leg edema of unclear etiology american board. The presentation of unilateral leg swelling is commonly encountered clinical practice, with deep vein thrombosis dvt often raised as the main diagnosis.
Common and important causes of unilateral leg swelling for doctors and medical students this page is currently being written and will be available soon. A 38yearold caucasian woman presented to the outpatient clinic with symptoms of hyperthyroidism lasting for approximately five months. Practical approach to lower extremity edema anmed health. 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. Ankle swelling may be the result of local, regional or systemic disease. Feb 22, 2016 unilateral leg swelling is more often due to local causes eg, deep vein thrombosis or cellulitis.
Mar 06, 2018 nonpitting edema is a type of swelling thats usually due to a problem with your thyroid or lymphatic system. Unilateral, localized bullous pemphigoid in a patient with. She first noticed these symptoms 4 years ago after giving birth to her second child. Unilateral iliac vein occlusion, caused by bladder. Differential diagnosis for unilateral leg swelling.
This article provides clinically oriented recommendations for the management of leg edema in adults. Edema exercises to improve drainage you will improve your lymph flow by doing a few exercises each day. A 9yearold girl presented with a 10day history of swelling of the left leg that occurred spontaneously and gradually increased in size by 33%. However, not infrequently, a range of pathologies are instead diagnosed. Jul 26, 2012 unilateral leg swelling and hydronephrosis article pdf available in qjm. A 65 year old man described swelling in both legs, which had worsened over six weeks. Unilateral leg swelling in a diabetic should suggest a muscle infarct. Unilateral leg swelling secondary to venous insufficiency. Differential diagnosis, investigation, and current. Right leg pain and swelling and redness and warmth 46 yo female with sudden onset right lower leg pains and chills. Algorithm for the diagnosis of unilateral lower extremity edema.
Bedside pointofcare ultrasound pocus revealed left moderate hydronephrosis. An obscure cause of leg edema, nonhodgkins lymphoma. The presentation of unilateral leg swelling is commonly encountered clinical practice, with deep vein thrombosis dvt often raised as the main. I got him a hospital bed at home so he could have his legs raised all the time. He also reported vague abdominal discomfort and tiredness. Unilateral leg swelling in an adolescent girl rheumatology. Hypertrophy of soft tissue or bone klippeltrenaunay syndrome overgrowth of body part proteus syndrome postthrombotic syndrome. The outpatient with unilateral leg swelling sciencedirect. A ct of the abdomen showed a bulky soft tissue mass in the region of. 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. Examination of the lower limbs revealed pitting oedema bilaterally up to the groin, but no erythema, tenderness, or warmth. Table 1 lists the most common causes of leg oedema that present to gps today. Unilateral means that the swelling appears only on one leg, while bilateral means that both legs are swollen.
An international journal of medicine 1067 july 2012 with 297 reads how we measure reads. What are the causes of unilateral upper limb edema. To be updated when it is complete please like us on facebook, follow us on twitter or subscribe on youtube using the follow us buttons. These conditions could be vascular or non vascular. While it is common to have swollen lower extremities postpartum as fluid shifts occur after delivery, this is usually bilateral. In three of these patients, the diagnosis of lymphoma was overlooked during the initial presentation, and appropriate therapy not given at that time. Jul 19, 2015 right leg pain and swelling and redness and warmth 46 yo female with sudden onset right lower leg pains and chills. It is important to be aware of other causes of the unilateral swollen leg to avoid unnecessary anticoagulation and potential missed diagnosis. Unilateral upper limb edema refers to the swelling of the soft tissues of either the right or left arm or hand.
A case that demonstrates this condition is described. If the onset of oedema is acute often unilateral leg lymphoedema may occur secondary to radiation, surgery, compression by a tumour or early filariasis infection. There is little guidance for the utility of bnp levels in identifying hf in patients that present primarily with leg edema and without dyspnea. A heretoforeunderappreciated condition that may lead to unilateral iliac vein compression, simulating dvt, is massive enlargement of the bladder caused by urinary retention. Leg swelling caused by the retention of fluid in leg tissues is known as peripheral edema. In some cases of bilateral leg swelling, one leg might appear bigger than the other one, thus looking like unilateral leg swelling.
Acute unilateral limb swelling is a clinical problem that can be categorized as one of two major groups, the majority of them is compatible with acute deep venous thrombosis dvt and actually the patients dont have venous thrombosis but readily have another disorder e. Downloaded from the american family physician website at. The most common cause is venous insufficiency, which usually manifests bilaterally. It took about a month, but the edema eventually went away, as did the ascites.
If it occurs in the upper extremity, it is usually due to problems with drainage of the blood or lymph from the arm. Sometimes leg swelling can indicate a more serious disorder, such as. Feb 18, 20 the swollen leg swelling is a sign for many conditions affect the human body. We report an unusual case of unilateral leg swelling secondary to cavernous lymphangioma cystic hygroma, which normally affects the head and neck regions. Knee lifts sit with your knees bent and hipwidth apart. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. 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.
Unilateral leg swelling in an infant adc education. Jul 15, 20 unilateral swelling from compression or compromise of venous or lymphatic drainage can result from dvt, venous insufficiency, venous obstruction by tumor e. The swelling is mostly gone in the left leg but only about 50% reduced in the right thigh. Unilateral pitting edema of the leg as a manifestation of. There was no history of fever, trauma, local foot infection, pain in the limb or difficulty in walking. There was no circulatory compromise of the left leg, and he.
Later, she turned out to be a case of nonhodgkins lymphoma. The skin of the left lower leg was pink and hot, and pitting oedema was noted. Swelling or puffiness of the skin, causing it to appear stretched and shiny. I do have a follow up with my primary care physician on 1125 but the research i have been able to do at the library and on line gives me the belief that i might need to do more to reduce the swelling. Unilateral leg edema is a frequent clinical problem, usually reflecting underlying vascular disease. Unilateral, localized bullous pemphigoid in a patient with chronic venous stasis connie r. A fundamental understanding of typical clinical presentation helps in narrowing this broad differential. Facial swelling is a common problem in the pediatric population with a variety of causes, ranging from congenital to acquired diseases.
Not all swollen legs require investigation and treatment. Treatment is based on addressing underlying disease process. Jan 12, 2019 4 possible unilateral upper leg swelling causes the list below shows results from the use of our quiz by buoy users who experienced unilateral upper leg swelling. A variety of conditions cause unilateral leg swelling and thus mimic deep venous thrombosis dvt. Diagnosis and management of common causes of localized edema. Pain or tenderness in the leg which may be felt only when standing or walking. The effects of chronic venous disease complicated by ulceration. Stay in the correct posture while doing these exercises. Not infrequently, and at times unexpectedly, a different pathology can be encountered. A 25yearold female having asymptomatic edema of unilateral leg was provisionally diagnosed as a case of psoas abscess.
While doing these exercises, wear your compression wraps or garment. This typically is worse in the areas of the body that are closest to the ground because of gravity. Therefore, edema is generally the worst in the lower legs called peripheral edema after walking about, standing, sitting in a chair for a period of time, or at. Diagnosis and management american family physician. The most common cause of leg edema in older adults is venous insufficiency. The symptoms worsened as the day progressed and improved at night. 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. She reported discomfort and pain in the calf and upper thigh. Bilateral swelling is more commonly due to systemic conditions whereas unilateral swelling more often represents local pathology. Unilateral leg swelling is a very rare clinical feature in patients with ureteral cancer, caused by direct invasion or metastatic lymphadenopathy can result in.
A 35monthold, previously healthy, african american boy presented with 2 weeks of intermittent nightly leg pain and 1 week of unilateral. This article describes an uncommon cause of this presentation, malignant lymphoma, in ten cases. Unilateral leg lymphoedema may occur secondary to radiation, surgery, compression by a tumour or early filariasis infection. Swelling in one leg during pregnancy doctor answers. Approach to leg edema article pdf available in italian journal of medicine 1. What is the differential diagnosis of chronic leg edema in primary. We were unable to find existing practice guidelines that address this problem in a comprehensive manner. The rest of the history and examination were unremarkable. Case report a 23yearold woman presented at the clinic with worsening swelling and tenderness and easy bruising in her left leg and ankle ongoing for 6 months.
In general, chronic swelling of one leg is more likely to be local whereas bilateral swelling usually has a systemic cause such as cardiac failure, but may be due to a local or. The swollen leg swelling is a sign for many conditions affect the human body. Many of the causes of leg swelling, such as an injury or prolonged standing or sitting, are common, easily identified and no reason for concern. It can be caused by a problem with the circulatory system, the lymphatic system or the kidneys. The diagnosis can be narrowed by categorizing the edema according to its duration, distribution unilateral or bilateral and accompanying. Nov 30, 2017 a 65 year old man described swelling in both legs, which had worsened over six weeks. An 8monthold boy presented with a weeks history of left lower limb swelling. 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. Unilateral lower limb swelling secondary to cavernous. Remarkably, she had developed pitting edema of her left leg four months. Approach to leg edema of unclear etiology american board of.
Follicular lymphoma recurrence presenting as unilateral leg. Swollen ankles are a common complaint in primary care and are often difficult to manage. 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. Walking difficulty and leg swelling murtaghs general. Unilateral swelling of the leg andor foot or along a vein ppt. Deep vein thrombosis remains one of the more common and clinically significant causes, particularly in view of the associated risk of pulmonary embolization. People with stasis dermatitis usually experience swollen legs and feet, open sores, or itchy and reddish skin. An often missed etiology for unilateral painful swollen leg. A noncardiac cause of bilateral leg swelling the bmj.
The significance of leg swelling varies according to the age group, whether it is bilateral or unilateral, and whether the onset is sudden or gradual see table 69. 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. Leg swelling isnt always a sign of a heart or circulation problem. The patient was otherwise systemically well with normal heart sounds and a clear chest examination. Mar 25, 2020 many factors varying greatly in seriousness can cause leg swelling. Imaging of the unilateral swollen painful lower leg.
Unilateral leg swelling and redness digital nomad physician. The key to diagnosis and management is a thorough history and examination to determine the primary pathology, which includes inflammation, infection or. While breathing in, slowly roll your legs in from the hip joints. Oct 23, 2015 leftsided leg edema of the elderly the journal of the american predominandy rightsided edema p unilateral leg swelling is a common clinical presentation, with deep vein thrombosis dvt often the top differential. These exercises are an important part of your home program. The diagnosis is confirmed by mri which shows the mass with high signal intensity in t2weighted images and gadolinium enhancement. If the swelling is unilateral andor accompanied by pain, would recommend seeking evaluation to confirm not a deep vein. Doppler ultrasonography ruled out deep vein thrombosis. Graves hyperthyroidism has a number of wellrecognized but relatively rare extrathyroid manifestations such as thyroid acropachy, pretibial myxedema, and congestive heart failure. Summary unilateral lower extremity edema below the knee commonly results from deep venous thrombosis, ve. A 35monthold, previously healthy, african american boy presented with 2 weeks of intermittent nightly leg pain and 1 week of unilateral, progressive. She had unilateral, right, lower limb oedema extending upto the knee and pitting in nature. Etiology onset and location examination findings evaluation methods treatment. The acutely swollen knee is a common presentation of knee pathology in both primary care and the emergency department.
Obesity is associated with sleep apnea and venous insufficiency. Follicular lymphoma recurrence presenting as unilateral. Lower extremity oedema is a frequent symptom in the primary care setting. Hypothesis the causes and management of lower limb lymphedema in the western population are different from those in the developing world objective to look at the differential diagnosis, methods of investigation, and available treatments for lower limb lymphedema in the west data source a pubmed search was conducted for the years 19802002 with the keyword lymphedema. Bilateral edema can be due to a local cause or systemic disease, such as heart failure. He was apyrexic, well and developmentally age appropriate. Although this disorder has been reported only three times before. This list does not constitute medical advice and may not accurately represent what you have. Sometimes, it is actually very hard to tell one from the other. Department of hospital medicine, cleveland clinic foundation, 9500 euclid avenue, mail code a, cleveland, oh 44195, usa. Doctors give trusted, helpful answers on causes, diagnosis, symptoms, treatment, and more.
A 25 year gentleman presented to our department with a year history of gradually increasing unilateral leg swelling and recurrent infections. A population based perspective of the hospital incidence and casefatality rates of deep vein thrombosis and. Nonpitting edema is a type of swelling thats usually due to a problem with your thyroid or lymphatic system. 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. Jan 01, 20 facial swelling is a common problem in the pediatric population with a variety of causes, ranging from congenital to acquired diseases.
Leg swelling causes mayo clinic mayo clinic mayo clinic. Deep vein obstruction and leg swelling caused by femoral. Unilateral leg swelling is a common clinical presentation, with deep vein thrombosis dvt often the top differential. On presentation, his vital signs were stable and physical exam was remarkable for left leg pitting edema and tenderness to palpation of left calf with purple discoloration. No fevers and reports she gets chills at times but doesnt feel well right now. Download fulltext pdf approach to leg edema article pdf available in italian journal of medicine 1. Pdf unilateral leg swelling and hydronephrosis mohamad. Differential diagnosis for unilateral leg swelling oxford. Many factors varying greatly in seriousness can cause leg swelling.
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