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Swollen legs: diagnosis
Because of the numerous causes that can lead to swelling on the legs, a clear diagnosis can be extremely complex. However, the first swellings often indicate the possible causes of the fat legs. Is the swelling unilateral or bilateral? Does it occur on the foot, ankle, lower leg, knee, hip or whole leg? Are the swellings long-lasting or rather short-term in nature? What is the nature 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 a first impression of the causes of the leg swelling. Then various diagnostic methods are used depending on the possible triggers of the disease, whereby the previous course of the symptoms should always be taken into account.
Diagnosis of venous diseases
With the exception of varicose veins, venous disorders are often relatively difficult to identify. If there is suspicion that impairment of the veins is the cause of the thick legs, venous diseases in the family environment can provide additional evidence of a possible hereditary disposition. The intensity and localization of the leg swellings also allow conclusions to be drawn about any existing venous disease. The complexion offers the doctor additional clues for the diagnosis of venous disorders. The arteries are also scanned and monitored to check their condition.
Special ultrasound examinations and so-called color duplex sonography also enable a check of the blood flow in the veins. This can not only provide evidence of impaired venous function, but can also be used to determine venous thrombosis. In addition, to determine a venous thrombosis in case of doubt, a special X-ray examination with a contrast medium can be carried out, which serves to display the deep veins and their venous valves. To determine the blood flow or blood return flow, a so-called occlusion plethysmography can also be carried out, in which the change in volume in the tissue is determined and analyzed. A check of the venous pressure is also possible. In order to diagnose 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 blood plasma are a result of activated blood clotting and the breakdown of blood clots. If values of more than 0.5 milligrams of D-dimer per liter of blood plasma are reached, this is a possible indication of a calf vein or leg vein thrombosis.
Diagnosis of lymphatic and thyroid disorders
The diagnosis of lymphatic disorders can usually be recognized relatively clearly on the basis of the manifestation of the edema. The typical swelling of the toes provides a clear indication of a possibly existing disease of the lymphatic vessels. In addition to assessing the swelling in the legs and hands, an examination of the arteries, lymph nodes, veins and cardiovascular function is also planned to enable a clear diagnosis of the lymphatic disorders. Methods of so-called lymph scintigraphy (nuclear medical procedures for the representation of lymph channels and lymph nodes) can also help in the detection of lymph 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 you suspect thyroid disease as the cause of the swollen legs, the thyroid values can be checked relatively easily using a blood test. If the blood samples provide evidence of underproduction of the thyroid hormones, further diagnostic methods such as ultrasound examination, the taking of tissue samples and nuclear medical examination methods with weakly radioactive substances as contrast media are available in order to analyze the damage to the organ more precisely. These examinations also serve to rule out a possible thyroid cancer.
Examinations for suspected heart failure
In order to check chronic heart failure as a possible cause of the swollen legs, a physical examination with listening and tapping the chest, palpating the body for edema, and pulse and blood pressure measurements is provided in the first step. Swollen vessels can also be found when palpating the body, such as right-sided heart failure in the area of the neck veins. In addition, if you suspect cardiac insufficiency, recordings of the cardiac current curve via a so-called electrocardiogram (EKG) are appropriate. An ultrasound examination of the heart can also provide information about a possible weak heart. Furthermore, magnetic or computer tomography of the heart may have to be carried out in order to examine the condition of the organ and in particular the coronary arteries in more detail. Blood tests can also help diagnose chronic heart failure.
Finding liver or kidney disease
If a liver disease is suspected, a thorough physical examination is appropriate, which in addition to palpating the liver for noticeable changes, blood tests in the laboratory, ultrasound examinations and possibly an analysis of tissue samples of the liver (liver biopsy). Imaging methods of computer tomography (CT) and / or magnetic resonance tomography (MRT) can also be used here, not least to exclude a disease of liver cancer.
If kidney disease is suspected to trigger the swollen legs, this can also be checked using blood tests. Urine tests can also clarify this. There are usually increased amounts of special proteins and blood cells in the urine. In the case of kidney disease, the blood sample usually shows a low level of the protein albumin. In addition, ultrasound examinations of the organ are provided in the case of suspected kidney disease, also in order to examine the damage to the kidney more precisely. In addition, a tissue sample (kidney biopsy) can provide additional information about the condition of the kidneys. As part of the diagnosis, the doctor also determines whether the kidney impairments have an acute cause or are caused by chronic diseases such as diabetes or heart failure.
Other diagnostic procedures
In the case of leg swelling, the diagnostic methods of sonography (ultrasound) and the imaging examination methods (MRT, CT) can also be used to diagnose other diseases such as a Baker's cyst or lipedema. Overall, the possible approaches to medical diagnosis are extremely variable, although a detailed amnesis should always be given at the beginning of the diagnosis in order to take the patient's previous course of symptoms into account and thus provide information on possible causes of the swollen legs. Because the leg swellings can be based on extremely serious illnesses, a medical examination should be carried out in any case. (fp)
Treatment of thick legs
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr. Fabian Peters
- Professional association of German internists e.V .: edema: examinations & diagnosis (accessed: 07.10.2019), internisten-im-netz.de
- Gerd Herold: Internal Medicine 2019, self-published, 2018
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- Peter Fritsch: Dermatology Venereology, Springer, 2nd edition, 2003
- Caitriona Canning, John R Bartholomew: Lipedema, Vascular Medicine, Sage Journal, Issue 23, November 2017, journals.sagepub.com
- Mayo Clinic: Lymphedema - Diagnosis & treatment (accessed: October 7, 2019), mayoclinic.org