Swollen Legs

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of bilateral leg swelling

Location: ‍anklesfeetcalvesthighs

Severity is ‍mildmoderatesevere

Onset was ‍gradualsudden

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍pain in the legs

‍redness

‍skin changes

‍shortness of breath

‍orthopnea

‍paroxysmal nocturnal dyspnea

‍fatigue

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍palpitations

‍dizziness

‍fainting

‍unexplained weight gain

‍abdominal bloating

‍decreased urine output



Contributing factors:

‍obesity

‍sedentary lifestyle

‍excessive salt intake

‍recent surgery

‍long flights or car rides

‍long periods of immobility

‍pregnancy

no history of: ‍heart failure, ‍kidney disease, ‍liver disease, ‍venous insufficiency, ‍deep vein thrombosis

no use of: ‍calcium channel blockers, ‍NSAIDs, ‍corticosteroids, ‍hormone therapy, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Chronic venous insufficiency ‍likelysuspectedpossible

DDx: heart failure, chronic venous insufficiency, renal disease, liver disease, medication-induced edema, lymphedema, deep vein thrombosis, obesity, pregnancy, hypoalbuminemia, malnutrition, thyroid disease, constrictive pericarditis, tricuspid regurgitation, pulmonary hypertension, venous obstruction, cellulitis, myxedema, idiopathic edema, acute nephritic syndrome, compartment syndrome





PLAN:

Investigations:

- Chest X-ray

- ECG

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍glucose, ‍BNP, ‍albumin, ‍LFTs, ‍TSH

- Urinalysis

- Echocardiogram

- Leg doppler ultrasound

- CT scan of the abdomen to rule out abdominal mass compressing the IVC

Treatments:

- Leg elevation

- Compression stockings

- Sodium restriction

- Fluid restriction

- ‍Diuretics

- Reassess medications that may contribute to edema (calcium channel blockers, NSAIDs, corticosteroids, hormone therapy)

Further care:

- Referral to cardiologist

- Referral to internist

- Follow-up in ‍ ‍weeksmonths

- Return if edema worsens, if new symptoms develop such as shortness of breath or chest pain