Swollen legs

Question 1

ΔΔ bilateral swelling?

Answer 1

• RHF
• ↓ albumin (test urine protein)
• venous insufficency (if chronic, ulcers, eczematous skin)
• vasodilators
• pelvic mass
• IVC obstruction (doesn’t extend to sacrum)
• pregnancy (chek BP and urine protein!)

Question 2

ΔΔ unilateral swelling?

Answer 2

• DVT (painful, red)
• cellulitis (hot, painful, red)
• insect bites (blisters)
• nec fasc
• trauma (sensation, pulses, severe pain on passive movement)
• compartment syndrome (fasciotomy!)
• arthritis (stiff)
• Baker’s cyst rupture (impaired mobility)

Question 3

Qs to ask in Hx?

Answer 3

• both legs?
• is she pregnant?
• immobile?
• trauma?
• pain?
• pitting oedema?
• DHx?
• skin changes?
• oedema elsewhere?

Question 4

Ix swelling?

Answer 4

BEDSIDE:
• urine dip (proteinuria, pregnancy)
• swab (cellulitis)

BLOODS:
• hypoalbuminaemia (=nephrotic syndrome)

IMAGING:
• X-ray (trauma)
• US duplex (DVT)
• ECHO (RVF)