The Diagnosis Strategy Of Unilateral Lower Limb Swelling

Objective: To summarize diagnostic strategy of unilateral lower limb swelling.Methods: Retrospective analysis of 357 patients hospitalized with unilateral lower limb swelling from March 2013 to October 2014.Results: 86.0 percent(307 cases) patients came to hospital within 2 weeks since the symptom onset, the most common reason was lower extremity deep vein thrombosis(DVT)(281 cases), other causes included infection(11 cases), hematoma(7 cases), lymphatic obstruction(4 cases), iliac vein compression syndrome(2 case), pelvic tumor compression(1 case), arteriovenous fistula(1 case). Etiology for chronic swelling contained post-thrombotic syndrome(33 cases), arteriovenous fistula(5 cases), lymphatic obstruction(5 cases), Klippel-Trenaunay syndrome(3 cases), pelvic tumor compression(3 cases), iliac vein compression syndrome(1 cases). Up to 60.5% lower limb swelling which were not due to DVT had histories of misdiagnosis as DVT. All cases of lymphatic obstruction were secondary to malignant tumor itself or the sequel of treatment. 94.6% of patients received lower limb doppler ultrasound, 16.6% of patients needed further CT-Venography(CTV) or CT-Angiography(CTA), 2.8% of patients received radionuclide lymphoscintigraphy.Conclusion: Although DVT was the main cause of unilateral lower limb swelling, the lower limb swelling which is not due to DVT was frequently misdiagnosed and belatedly treated. Considering the complexity and reciprocal overlapping for the etiology of lower limbs swelling, developing a appropriate diagnosis strategy is important. Apart from history taking and physical examination, we suggested color doppler ultrasound for the lower limb should be the preferred imaging examination mean of lower limb. Pelvic cavity screening for occupancy lesions and iliac vein should be evaluated synchronously if possible. For cases which can’t be diagnosed by ultrasound, CTV, CTA and radionuclide lymphoscintigraphy could be important supplement to assist the diagnosis.