Chronic Lower Extremity Edema
Lower limb edema .
The lower-limb edema may be unilateral or bilateral and takes on different meanings . The review will also look at whether it is of acute onset or is chronic . In all cases, we will consider whether the edema is venous or lymphatic .
Venous edema is often a soft swelling , Pitting, with increased local heat and increasing standing .
The lymphatic edema is rather firm , does not the bucket . The blue test is abnormal in that the injection of patent blue subcutaneously is not accompanied by a reduction along the lymphatic channels but spreadsheet under the skin .
LACE OF VARIOUS TESTS IMAGING
In suspected cases of phlebitis, The Doppler confirms the diagnosis and clarifies if possible the seat of the clot. If it is proximal (iliofemoral) , the risk of embolism leads to practice phlebocavographie which can be supplemented if necessary by placing a filter endoluminal .
If the edema is unilateral but chronic. The venography look for arguments in favor of a chronic phlebitis . If venography is normal , the etiology lymphatic will be demonstrated by a test and a blue lymphatic blockage by lymphography.
Edema can finally have a cause the joint compression process, especially in the scarpa ; it can be caused by arteritis or an arteriovenous malformation as Klippel-Trenaunay .
If the edema is bilateral , after eliminating the general causes , will seek a bilateral phlebitis or compression by a cave phlebocavographie. The absence of a venous anomalies will find a lymphedema and its causes . Note that the compression or invasion by a retroperitoneal process, edema is often mixed : venous and lymphatic
QCM 13.1: before a vein substitute suprapubic , what is the diagnosis to evoke ?
A - iliac vein thrombosis ,
B - arteritis associated ,
C - valvular insufficiency ,
D - SVC thrombosis ,
E - sural thrombosis .
QCM 13.2: Radiological signs which can be seen in the aftermath of DVT when venography performed in the lower ?
A - irregular contours venous ,
B - gaps in the image cup, surrounded by the contrast,
C - laminated aspect of the venous system ,
D - pack vascular
E - arteriovenous fistula .
QCM 13.3: A patient has bilateral edema of the lower . Phlebography revealed extrinsic compression of the inferior vena cava . The examinations for first-line guiding the etiologic diagnosis are:
A - abdominal and pelvic ultrasound ,
B - aortography ,
C - abdominopelvic CT ,
D - cavography by jugular
E - MRI pelvis .
QCM 13.4: What is the review to be carried out before a unilateral chronic swelling of the lower limb. When the Doppler is normal?
A - pelvic CT ,
B - cavography,
C - after lymphography blue test ,
D - arteriography ,
E - Monitoring .