One of the most common complaints in medicine is swollen legs. Swelling of the legs or “leg edema” is a manifestation of an underlying disease that needs to be found. Many pathologies can cause swollen legs, and in many patients, we can see multiple co-existing problems contributing to the development of edema, at the same time.
Having a simple but comprehensive framework to find your way through this convoluted path is necessary to avoid delayed diagnosis and prevent many unwarranted investigations.
The four main contributors to swollen legs are Venous Hypertension, Medications side effects, Lymphedema and Lipedema.
Venous Hypertension: As the name implies, is the involvement of the venous system with raised pressures which has two leading players: Obstruction and Chronic Venous Insufficiency (CVI). CVI is one of the most common causes of swollen legs. Heart Failure as one of the leading causes of swollen legs, can be classified here, as the main end pathophysiology causing edema is Venous Hypertension (increased pressure in the venous system). Apart from physical exam and history taking, the diagnosis of Heart Failure also requires an Echocardiogram (Heart Echo).
Lymphedema: Involvement of the lymphatic system by various pathologies, which causes the accumulation of the lymph in the interstitium (the space between the cells), resulting in the swelling and edema of the different affected organs. The main cause of lymphedema in developed countries, is cancer and cancer-related treatments including chemotherapy, radiotherapy and surgery. The main cause of this problem worldwide, is parasitic infections.
Lipedema: This is an excessive and abnormal accumulation of the fat in various organs that starts early in life and has a significant genetic background. There are significant differences between Lipedema, Lymphedema and Chronic Venous Insufficiency, that I will discuss in future posts and videos.
In the following video, I have expanded on Venous Hypertension with some interesting cases to help with early diagnosis and management. In future videos, I will talk about other causes of swollen legs.