Concluded Case

50 years male with sudden onset lower limb oedema

Unilateral lower limb oedema Chief Complaints Unilateral left whole limb oedema- 15 days,duration History 15 days,back - 50 years male development sudden onset left lower limb oedema of whole limb Vitals All vitals are normal Physical Examination Left lower limb swelling uniform- from inguinal region to foot - left inguinal lymph nodes are palpable Investigations Colour doppler study of left lower limb is normal No DVT Left inguinal lymph nodes are seen F.N.A.C of inguinal lymph nodes - report is awaited Diagnosis Needs to be established as F.N.A.C of inguinal lymph nodes is awaited Management Opinions are awaited from experts in curofy

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Concluded answer

It was a difficult case to diagnose- considering sudden onset increasing whole limb oedema in 15 days with no fever, tenderness- ruling out Acute infection or filariasis. Also colour doppler was normal - ruling out DVT Clue to the diagnosis was inguinal lymphadenitis- non - tender F.N.A.C report which came today was surprisingly and it seems the mystery like in a Sherlock Homes Novel just started unfolding F.N.A.C showed - mitotic cells in a foamy background. It means - we are dealing with a malignant disease and such a short history and massive lymphoedema supported it . As now - patient was not in my domain for further treatment- I referred the patient to P.G.I for further evaluation

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It was a difficult case to diagnose- considering sudden onset increasing whole limb oedema in 15 days with no fever, tenderness- ruling out Acute infection or filariasis. Also colour doppler was normal - ruling out DVT Clue to the diagnosis was inguinal lymphadenitis- non - tender F.N.A.C report which came today was surprisingly and it seems the mystery like in a Sherlock Homes Novel just started unfolding F.N.A.C showed - mitotic cells in a foamy background. It means - we are dealing with a malignant disease and such a short history and massive lymphoedema supported it . As now - patient was not in my domain for further treatment- I referred the patient to P.G.I for further evaluation

Gross left lower limb edema Most likely to be lymphoedema secondary to Inguinal lymphadenopathy ? Filariasis Look for eosinophilia, lymph node biopsy and histopathology USG abdomen/ CT abdomen to look for iliac lymphadenopathy or intraabdominal pathology If eosinophilia present, empirical treatment for filariasis

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U/L lower limb edema causes 1) DVT 2) Cellulitis 3) Filariasis 4) Malignancy(abdomen /pelvic) USG /CT abdomen, ESR, CBP. Management depends upon the underlying condition.

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OEDEMA LEFT LOWER LIMB .. ? LYMPH PATHOLOGY.. ? FILARIASIS .. ? MALIGNANCY.. ? POST UNKNOWN BITES ..CELLULITIS..

Tnx Dr Vipin Bihari Jain sir
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Lower limb oedema waiting for F. N.A.C report. CBC, CRP BS(F) PP, HbA1c, UREA CREATININE SODIUM POTASSIUM and URINE FOR RE, ME, C&S Test will be done??

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P.Fillarial infestation..??? Poisonous insect bite ?

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Subcutaneous edema ? Cause CBC esr Filarial serology for the sake of complete evaluation Should we rule out iliac vein occlusion ? Just a hunch.

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Lymphoedema with inguinal lymphadenopathy Line of treatment after fnac or biopsy report

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POSSIBLY LYMPHOEDEMA WITH LYMPHADINITIS.. POSSIBLY INFECTIVE. ORIGIN DD SECONDARY. TO POISONOUS INSECT. BITES

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? maligncy, ?if fever,&count increased then insect bite or infection

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