Swollen legs

• Differential diagnosis

  Usually due to fluid leak from veins or lymphatics. Most are 'pitting' (remains indented after pressing), but hypothyroidism and lymphoedema are 'non-pitting'.

  Bilateral:

  • Venous insufficiency, usually due to age-related venous valvular incompetence.
  • Right heart, liver or renal failure.
  • Dependent oedema: effect of gravity when sitting for a prolonged period.
  • Pregnancy
  • Calcium channel blockers.
  • Hypothyroidism

  Unilateral:

  • Venous insufficiency: can be uni- or bilateral.
  • DVT
  • Cellulitis
  • Lymphoedema e.g. from pelvic mass.

• Lymphoedema

  Tissue swelling due to fluid leakage from lymphatic vessels.

  Primary lymphoedema

  Congenital lymphoedema (aka Milroy disease):

  • Autosomal dominant disease.
  • Usually bilateral.

  Lymphoedema praecox (aka Meige disease):

  • Onset between birth and 35 years old, usually in puberty. 4 times commoner in women.
  • Commonest cause of primary lymphoedema.
  • Usually unilateral.

  Lymphoedema tarda:

  • Onset >35 years old.
  • Uncommon

  Secondary lymphoedema

  Causes:

  • Cancer
  • Surgery
  • Radiotherapy

  Management

  Compression stockings and elevation.