Leg Swelling- Case Presentation,

1. A Case Leg Swelling

2. Case Summary :
Md. Mahibullah, 15 years old male, a student
of classVII , hailing from Titash,Comilla,
belongs to a poor socio economic status,
attended on 8th
November’2014 with the
complaints of swelling of left leg for 2 years &
right leg for 1 year.
The swelling started at the dorsum of the foot
and gradually extended upto the leg. He also
states that the swelling is slightly reduced after
keeping the lower limbs elevated for a while.

3. (Case Summary) Continue...
This swelling was not associated with any
pain or weakness in lower limbs, fever, any
change in voice, cold intolerance, weight
gain, dry skin, constipation.
During this period, he did not give any H/O
breathlessness, cough, chest pain, abdominal
swelling, facial puffiness.

4. (Case Summary) Continue...
His bladder & bowel habit is normal.
But there is a H/O lethargy & stunted
growth. His secondary sexual characteristics
are not yet developed. His attendant did not
give any H/O mental retardation, impaired
vision or loss of hearing in association.

5. There is no significant past history like
Rheumatic fever, Jaundice.
His mother also has similar swelling of both
leg & feet for last 8 years. He has two
sisters.They are healthy & do not have any
such complain.
(Case Summary) Continue...

7. On Examination :
 Appearance- looks depressive
 Body Built- Average (Ht.-147 cm,Wt.-45kg)
 Anemia , Jaundice, Cyanosis – Absent
 Edema – Present(in both legs & feet),
Pitting (more in left leg)
 Eyes- Down slanting
 Palate- High Arched
 Neck-Webbing present
 Ears- Low set

8. Continue…
• Koilonychia- Absent
• Leukonychia- Absent
• Clubbing- Absent
• Lymph node- Not Palpable
• Thyroid gland- Not Enlarged
• Skin condition: Color of the skin is slightly
darker in left leg.An eczematous lesion is
present proximal to the left ankle joint.

9. Continue…
• Pulse-72/m, regular
• Blood Pressure – 110/70 mm Hg
• Resp. Rate -16 b/m
• Body temp .-98 F
̊
• Bed side urine test: Protein is absent.

12. Other systemic Examination
No Abnormality. Except-
Pulsation of Arteria Dorsalis Pedis &
Posterior Tibial Artery are not
perceptable in both side. Pulsation of
Popliteal arteries are present.

14. Investigation:
 CBC: (9.11.14)
Hb. – 11.8 g/dl
RBC- 4.33 million/cmm
MCV- 84.8 FL
MCH- 27.3 pg
Platelet – 3,42,000/cmm
ESR- 35 mm in1st
hr.
WBC – 8570/cmm
N- 38.2 %
L- 42.8%
M- 3.7%
E – 15.1%
• PBF: Non-specific findings.

15. (Investigation) Continue…
• S. Creatinine: 0.70 mg/dl
• S. Sodium : 140 mmol/l
• S. potassium : 4.49 mmol/l
• S. Chloride: 103 mmol/l
• Carbon Dioxide: 27 mmol/l
• C. Eosinophil count: 1000/cmm
(raised)
(09. 11. 14)

16. (Investigation) Continue…
(09. 11. 14)
• Urine R/E :
Albumin- Distinct trace
Pus cell (0-3)/hpf , Epithelial cell (5-6)/hpf
No Cast.
• Provocation test for Filaria: Negative
• S. Filarial Antigen: 49.5 U/ml (Negative)
• ICT for Filaria : Negative
(10. 11. 14)

17. (11. 11. 14)
•X-ray Chest : NAD
• X-ray Abdomen: NAD
• ECG: Normal
(Investigation) Continue…

18. On 26th
November’2014 the patient came for
follow up visit as per the discharge (17.11.14)
advise with the Lymphoscintigraphy report.
• Lymphoscintigraphy (24. 11. 14)
Patent lymphatic channels with
evidence of some lymphedema in lower
part of the legs, mainly on right side.
(Investigation) Continue…
• Doppler Venous Examination: Normal (no
DVT)
(11. 11. 14)

19. (26. 11. 14)
(Investigation) Continue…
• S.Albumin : 4.90 uIU/ml
• Total protein : 8.80 gm/dl
• A:G – 1.25: 1
• S.TSH: 4.59 uIU/ml
• S.FT4: 1.0 ng/dl

20. • USG of the whole abdomen:
Relatively smaller ectopic left kidney
(at left subumbilical region),right
kidney is normal. Other findings are
normal.
(27. 11. 14)
(Investigation) Continue…

21. The Diagnosis :
? Familial
Lymphedema Of
Lower Limb

22. Regarding the
diagnosis and
further plan …
Valuable Opinion
Please

23. Thank You