Idiopathic Unilateral limb swelling

U/L lower limb swelling under Ix Chief Complaints A 54 yr old male has come with complains of U/L left lower limb swelling for past 2 yrs. No associated pain, itching, edema not related to posture, non tender, no skin changes etc. No associated SOB, chest pain, oliguria, palpitation, icterus, pallor, distension of abdomen, alopecia, hot n cold intolerance etc No H/O T2DM, Thyroid disorder, substance abuse. He is a K/C/O of HTN, IHD- P/CABG 2013. Pt was advises routine blood Ix, TFT, Urine RE and 24 hr urinary protein, ECG, CXR doppler study of lower limbs ,PBS etc. His blood IX and Urine IX are normal except increased FBS and HbA1C, normal doppler study, ECG NSR, CXR NAD. TFT is normal, some reports are awaited. Started prophylactic treatment and kept pt under follow up.

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Unilateral lower limb swelling for 2 years means chronic one. So DVT does not fit for a cause in this case. So chronic causes may be due to lymphoedema may be due to deranged lymphatic drainage infective origin causing lymphadenitis or may be due to filariasis caused by microfilariae, when the dead parasite remains in lymph cannel causes obstruction causing lymphoedema. May be due to iatrogenic injury to lymphatic channel post operative Cause may be due to unilateral venous insufficiency due to compression on vein may be due to malignant tumour, Treatment Avoid long standing, Compressive stocking Physical exerscises

Thanks Dr Dinesh Gupta
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Possibilities are Lymphoedema Neurofibromatosis Hansen's Chronic venous insufficiency The following investigations are advised Skin biopsy Muscle biopsy Midnight blood sample for filariasis Filarial antigen test USG whole abdomen Once a workable diagnosis is arrived at we can plan the treatment

? LYMPHATIC .. PATHOLOGY..LYMPHEDEMA.. ? LIPEDEMA .. ? PRESSURE SYMPTOMS ..

POSSIBLY LYMPHEDEMA.. NEEDS FURTHER. EVALUATION

Probably lymphedema, what are those scars on both the legs ?

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