Diagnosis of swollen legs

Due to the many causes that can lead to swelling of the legs, a clear diagnosis can be extremely time-consuming. Often, however, already arise from the appearance of the first swelling indications of the possible causes of fat legs. Is the swelling unilateral or bilateral? Does it affect the foot, ankle, lower leg, knee, hip or whole leg? Are the swellings long lasting or rather short term? What is the texture of the fabric? Do the patients suffer from other symptoms at the same time? With the help of such questions, the therapist tries to get an idea of ​​the causes of leg swelling. Subsequently, according to the possible triggers of the disease, various diagnostic procedures are used, always taking into account the previous course of symptoms.

Diagnosis of venous diseases

Venous disorders are often relatively difficult to determine, except for the varicose veins. If there is any suspicion that impairments of the veins are the cause of the fat legs, venous diseases in the family environment can provide additional evidence of a possible hereditary predisposition. The intensity and localization of leg swellings also allow conclusions to be drawn about possible venous disease. The skin picture offers the physician additional clues for the diagnosis of venous disorders. Also, the arteries are scanned and eavesdropped to control their condition.

Special ultrasound examinations and the so-called color duplex ultrasonography also make it possible to check the blood flow in the veins. This can not only provide evidence of impairment of venous function but also serve to detect venous thrombosis. Furthermore, in case of doubt, a special x-ray examination with a contrast agent can be carried out to determine a venous thrombosis, which serves to visualize the deep veins and their venous valves. In addition, a so-called occlusive plethysmography can be carried out to determine the blood flow or blood reflux in which the change in volume in the tissue is detected and analyzed. A check of the venous pressure is also possible. In order to diagnose a venous thrombosis, an examination of the blood plasma for so-called D-dimer is also carried out in the laboratory. Increased D-dimer levels in the blood plasma are a consequence of activated blood clotting and the dissolution of blood clots. If values ​​of more than 0.5 milligrams of D-dimer are reached per liter of blood plasma, this is a possible indication of a vena cava or leg vein thrombosis.

Diagnosis of lymphatic and thyroid diseases

The diagnosis of lymphatic disorders is usually relatively clear already on the basis of the manifestation of edema. The typical swelling of the toes here provides a clear indication of a possibly existing disease of the lymphatic vessels. In addition to assessing the swelling of the legs and hands, an examination of the arteries, lymph nodes, veins and cardiovascular function is still provided to allow a clear diagnosis of lymphatic disorders. Also, methods of so-called lymphoscintigraphy (nuclear medicine methods for the presentation of lymphatics and lymph nodes) can help in the detection of lymphatic drainage disorders and malignant tissue changes. If an infection in the form of an erysipelas is suspected to be the cause of the lymphatic drainage disorders, this can be determined by checking the inflammatory values ​​in the blood. If a thyroid disorder is suspected to be the cause of swollen legs, it is relatively easy to check thyroid levels using a blood test. If the blood samples suggest evidence of underproduction of thyroid hormones, further diagnostic procedures such as ultrasound, tissue sampling, and nuclear medicine examination of low-level radioactive substances are available as contrast agents to further analyze damage to the organ. These studies also serve to rule out possible thyroid cancer.

Investigations in case of suspected heart failure

In order to check chronic heart failure as a possible cause of swollen legs, the first step involves a physical examination with listening to and tapping of the chest, palpation of the body for edema and pulse and blood pressure measurements. It is also possible to detect swollen vessels during palpation of the body, such as in right ventricular failure in the area of ​​the jugular veins. In addition, in case of suspected cardiac insufficiency, recordings of the cardiac output curve via a so-called electrocardiogram (ECG) are appropriate. Also, an ultrasound examination of the heart can provide information about a possibly existing heart failure. Furthermore, under certain circumstances, a magnetic or computerized tomography of the heart may be carried out in order to investigate the condition of the organ and in particular of the coronary vessels in more detail. Blood tests can also contribute to the diagnosis of chronic heart failure here.

Detection of liver or kidney disease

In case of suspected liver disease, a thorough physical examination is appropriate, which includes a palpation of the liver after noticeable changes, blood tests in the laboratory, ultrasound examinations and possibly an analysis of tissue samples of the liver (liver biopsy) provides. Imaging methods of computed tomography (CT) and / or magnetic resonance imaging (MRI) can also be used here, not least to rule out a disease of liver cancer.

If kidney disease is suspected to trigger the swollen legs, this can also be checked by blood tests. Also urine tests can bring clarity here. The urine usually contains increased amounts of special proteins and blood cells. In the blood sample, in the case of kidney disease, it is usually possible to detect an excessively low level of the protein albumin. Furthermore, in the suspected renal disease ultrasound examinations of the organ are provided, also to check the damage to the kidney in more detail. In addition, a tissue sample (renal biopsy) can provide additional information about the condition of the kidneys here. As part of the diagnosis, the doctor also determines whether the kidney impairment is an acute cause or caused by chronic conditions such as diabetes or heart failure.

Further diagnostic procedures

In leg swelling, the diagnostic procedures of ultrasound and imaging (MRI, CT) can also be used to diagnose other conditions such as a Baker's cyst or lipoedema. Overall, the possible approaches to the medical diagnosis are extremely variable, but in any case should be at the beginning of the diagnosis, a detailed amnesia, in order to take into account the past complaint history of patients and to gain clues to possible causes of swollen legs. Since the leg swelling can be based on extremely serious diseases, a medical examination should be carried out in any case.

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Treatment of fat legs