Differential diagnosis of lower limb swelling


 * Bilateral swelling DK - literally. systemic diseases.
 * Unilateral swelling DK - no. deep vein thrombosis or cancer.

Anamnesis

 * Emergence of swelling - suddenly (HT), slowly ( cardiac insufficiency );
 * soreness ( HVT, Baker's cyst );
 * after long-term immobilization (HŽT);
 * after trauma (muscle rupture, fracture, compartment syndrome );
 * accompanying onema (cardiac/renal insufficiency, liver cirrhosis ), cancer (especially small pelvis), influence of drugs ( BKK, corticoids , NSAIDs ).

Physical exam

 * Reddish hot skin – erysipelas, Deep Vein Thrombosis (DVT);
 * compressible edema – cardiac, renal, hepatic edema;
 * incompressible swellings ( lymphatic, lipidedema ).

USG examination - 3D Doppler

 * Vein patency.

Differential diagnosis

 * Vascular etiology;
 * DVT (unilateral, acutely formed, elastic, painful swelling - possibly with hot, tense skin);
 * thrombophlebitis (inflamed subcutaneous vein - a red, painful strip to the touch);
 * varices (one/bilateral compressible swelling, increasing during the day, decreasing with positioning);
 * chronic venous insufficiency /=CVI (unilateral/bilateral swelling, mostly with skin changes and/or leg ulcer );
 * neurological etiology (paresis for blood flow stasis for unilateral angioparesis, tendons are not usually affected);
 * cardiac etiology (right-sided insuf. – bilateral compressible on the instep and lower leg, characteristically increase after exertion, are smallest in the morning);
 * hypoproteinemic swellings (in hepatopathies – cirrhosis, renal – nephrotic syndrome, acute glomerulonephritis , protein loss in exudative enteropathy);
 * lipedema (chronic bilateral painless incompressible swelling – most obese women, with skin changes of the orange type, characteristically the insteps and tendons are spared);
 * lymphedema (chronic unilateral/bilateral swelling, characteristically affected also the insteps and tendons, the leg has the shape of a post, in extreme cases the development of elephantiasis );
 * pharmacologically conditioned (nifedipine, glucocorticoids, vasodilators, NSAIDs, hydralazine, minoxidil,...);
 * endocrine etiology (typically bilateral);
 * Basedow's disease (incompressible, pretibial myxedema, pasty skin, bluish-red, coarse pores);
 * hypothyroidism (generalized myxedema, especially in the face and all limbs);
 * traumatic etiology (mostly one-sided swelling, history of fracture, untorn meniscus, etc.);
 * postoperative (reperfusion swelling after vascular procedures (bypass, removal of vessel obliteration), great pain, the area is hot, often after removal of the great saphenous vein /=VSM);
 * compartment syndrome ;
 * neoplasia (typically unilateral in tumors – e.g.: tumors in the small pelvis, local swelling in osteosarcoma, Ewing's sarcoma );
 * inflammatory etiology ( erysipelas – red, painful swelling, we look for the entrance gate of the infection + we check vaccination against tetanus and possibly revaccinate);
 * Baker's cyst (unilateral soft swelling in the popliteal fossa, palpable resistance, USG examination is diagnostic).