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2. Differential diagnosis:
Usually due to fluid leak from veins or lymphatics. Most are 'pitting' (remains indented
after pressing), but hypothyroidism and lymphedema are 'non-pitting'.
Bilateral:
Venous insufficiency, usually due to age-related venous valvular incompetence.
Right heart, liver or renal failure.
Dependent oedema: effect of gravity when sitting for a prolonged period.
Pregnancy
Calcium channel blockers.
Hypothyroidism
Unilateral:
Venous insufficiency: can be uni- or bilateral.
DVT
Cellulitis
Lymphoedema e.g. from pelvic mass.
3. Lymphoedema:
Tissue swelling due to fluid leakage from lymphatic vessels.
Primary lymphoedema
Congenital lymphoedema (aka Milroy disease):
Autosomal dominant disease.
Usually bilateral.
Lymphoedema praecox (aka Meige disease):
Onset between birth and 35 years old, usually in puberty. 4 times commoner in women.
Commonest cause of primary lymphoedema.
Usually unilateral.
Lymphoedema tarda:
Onset >35 years old.
Uncommon
Secondary lymphoedema
Causes:
Cancer
Surgery
Radiotherapy
Management
Compression stockings and elevation.
