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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.

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