Leg Swelling (Leg Edema): Or something else? Differential Diagnosis

Leg swelling occurs unilaterally:

Skin and subcutaneous (L00-L99).

  • Allergic reactions

Cardiovascular system (I00-I99)

  • Arterial embolism (occlusion of a blood vessel; The embolus originates in the heart or large arteries and causes leg swelling by occluding a leg artery).
  • Arterial thrombosis (formation of a blood clot (thrombus) in an artery).
  • Arterial aneurysm (pathological (pathological) outpouching of an artery).
  • Aneurysm spurium (refers to a hematoma (bruise) located on the arterial wall that is associated with a tear in the arterial wall)
    • Can occur throughout the vascular course of a leg
  • Chronic venous insufficiency (CVI) – disruption of venous return as a possible consequence:
    • A venous thrombosis (blood clotting in a vein, leading to the formation of a blood clot (thrombus) there).
    • A primary varicosis (varicose vein disease)
    • Of a failure of the calf muscle pump in healthy veins.
    • Affected is the ankle region
  • Ischemia (reduced blood flow) in the arteries.
    • Hypoxic toxic edema
    • Toes and the front of the foot are pasty and swollen
  • Lymphedema – retention of lymphatic fluid in the tissues:
    • Often occurs on one side
    • Affected are ankles, feet and toes
    • In lymphedema, the swelling does not completely disappear overnight and the depressed dents remain for a long time.
    • Primary lymphedema (congenital).
      • Occurs in the majority of cases unilaterally
      • When it occurs bilaterally, the legs are swollen quite differently in severity
      • Not painful
    • Secondary lymphedema
      • Rarely occurs on the leg
      • Develop on the basis of another chronic edema disease (e.g., in chronic venous insufficiency), in malignant (malignant) diseases, or as part of the therapy of these
      • Progress from proximal (towards the center of the body) to distal (away from the center of the body).
  • Phlegmasia coerulea dolens – acute thrombotic occlusion of all veins of a leg, which may lead to loss of the limb.
  • Postthrombotic syndrome – chronic congestion of blood returning to the heart as a result of thrombosis:
    • Unilateral swelling
    • Chronic occurrence
    • Skin changes occur
  • Thrombophlebitis (inflammation of superficial veins with secondary formation of thrombosis).
    • Violently reddened strand
    • Very painful
  • Deep vein thrombosis of the leg (TBVT)
    • Acute onset: bulging calf, livid skin tone (poorly perfused, pale tissue).
    • The degree of swelling indicates the localization of thrombosis.
    • Painful; pain due to inflammation may occur several days before leg swelling.
    • Glossy skin
    • Overheating (Calor)
  • Varices (varicose veins)
    • Swelling is depressible
    • Improvement is achieved by elevation
  • Venous compression syndrome (due to tumor, retroperitoneal fibrosis, synovial cyst, aneurysm).

Infectious and parasitic diseases (A00-B99).

  • Infections such as erysipelas (erysipelas) → accompanying edema.
    • Acute onset: Erythema (redness of the skin), lymphangitis (inflammation of the lymphatic channels of the skin and subcutaneous fat; blood poisoning), redness and hyperthermia.

Musculoskeletal system and connective tissue (M00-M99).

  • Arthritis (inflammation of the joints) → accompanying edema.
    • Acute onset
  • Activated osteoarthritis (inflammatory episode of degenerative joint disease).
    • Acute onset
  • Baker’s cyst (popliteal: belonging to the popliteal fossa); popliteal cyst) – cysts usually become symptomatic only between the 20th and 40th year of life; but can also be observed already in the 1st decade of life; symptomatology: feeling of pressure in the area of the popliteal fossa with occasional radiation into the calf.
    • Acute occurrence due to ruptured synonvial cyst (joint cyst).
  • Muscle fiber tear with hemorrhage/hematoma.
    • Acute occurrence

Neoplasms – tumor diseases (C00-D48)

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99)

  • Overflow bladder (urine leakage when pressure in the filled bladder exceeds sphincter pressure)-may result in compression of a pelvic vein

Digestive system (K00-K93)

  • Cirrhosis of the liver – irreversible (non-reversible) damage to the liver and marked remodeling of liver tissue.

Injuries, poisonings, and other consequences of external causes (S00-T98).

  • Hematoma (bruise)
    • Acute occurrence
  • Injuries to the knee and ankle joint

Further

  • Too tight bandages

Leg swelling occurs bilaterally:

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Amyloidosis – systemic disease with deposition of proteins (albumen) in various organ systemsNote: If there is evidence of left ventricular hypertrophy with hypotension, this diagnosis is possible → for further diagnosis: adipose tissue biopsy.
  • Graves’ disease (form of hyperthyroidism (hyperthyroidism) caused by an autoimmune disease).
  • Cushing’s disease (group of diseases that lead to hypercortisolism (hypercortisolism; excess of cortisol)).
  • Myxedema (pasty (puffy; bloated) skin that shows non-push-in, doughy edema (swelling) that is not positional) – especially in the setting of hypothyroidism (hypothyroidism)
    • Typically in the area of the tibia
    • Not depressible
    • Nodular planar induration
    • Erythema (redness of the skin)
  • Hypothyroidism (underactive thyroid gland).
  • Protein malnutrition – in the context of:
    • Anorexia (loss of appetite)
    • Bulimia (binge eating disorder)
    • Cachexia (emaciation of the organism (emaciation) due to profound disturbance of one or more organ functions).

Cardiovascular system (I00-I99)

  • Ischemia (reduced blood flow) of the arteries.
  • Lymphedema
  • Pulmonary hypertension (PH; pulmonary hypertension)) – after recurrent thromboembolism, after pulmonary embolism, in chronic lung disease and severe sleep apnea syndrome (condition in which people experience breathing cessations during sleep).
  • Right heart failure – restriction of the pumping function of the right heart.
    • Leg swelling develops from the feet to the knees
    • When a lot of fluid builds up, tension blisters form on the skin. There may be fluid leakage or inflammation of the skin.
  • Thrombophlebitis (inflammation of superficial veins with secondary formation of thrombosis).
  • Deep vein thrombosis (TBV)

Liver, gallbladder, and bile ducts-pancreas (pancreas) (K70-K77; K80-K87).

  • Hepatic insufficiency (liver function is impaired).
    • Hypalbuminemic edema is typical (a consequence of hepatic synthetic dysfunction)
  • Liver cirrhosis – irreversible damage to the liver, leading to a gradual connective tissue remodeling of the liver with impairment of liver function.

Neoplasms – tumor diseases (C00-D48).

  • Abdominal, mostly gynecologic benign (benign) or malignant (malignant) tumors.

Psyche – nervous system (F00-F99; G00-G99).

  • Alcohol abuse

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99)

  • Idiopathic edema (water retention with no apparent cause) – swelling around the ankles, fingers, face, and abdomen. Weight gain >1.4 kg during the day with low urinary output, but marked nocturia (nocturnal urination).
  • Lipedema – chronic disease of the subcutaneous fat tissue or subcutaneous fat tissue proliferation.
    • Most often occurs in the thigh and knee region.
    • Pressure painful
    • Not pressable
    • Affected are post-pubescent girls and women
  • Edema (leg edema) due to cardiac, renal, arterial or venous cause.

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Chronic renal failure (kidney weakness) – edema in the legs is rare in kidney disease, more common in the face; weight history?
  • Glomerulonephritis (inflammation of the glomeruli (renal corpuscles)).
  • Nephrotic syndrome – collective term for symptoms that occur in various diseases of the glomerulus (renal corpuscles); symptoms include:
    • Proteinuria (increased excretion of protein in urine) with protein loss greater than 1g/m²/body surface area per day; hypoproteinemia,
    • Peripheral edema due to hypalbuminemia of < 2.5 g/dL in serum,
    • Hyperlipoproteinemia (lipid metabolism disorder).
  • Premenstrual syndrome (PMS) – occurs in women about four to fourteen days before their next period and involves a complex picture of different symptoms and complaints
    • Predominantly affects the ankle area

Medication

* Thrombosis/embolism caused by drugs.

Further

  • Pregnancy