The swollen leg

Compressão extrínseca de veia ilíaca externa e edema de membro inferior por cisto sinovial coxofemoral

A trombose venosa profunda (TVP) é uma freqüente causa de edema unilateral de membros inferiores. O cisto sinovial da articulação coxofemoral pode ser uma causa rara desse sintoma e deve ser considerado no diagnóstico diferencial. Apresentamos um caso clínico em que o eco-Doppler colorido revelou a presença de compressão extrínseca da veia ilíaca externa. A ressonância magnética demonstrou tratar-se de cisto sinovial como fator etiológico, confirmado pela ressecção cirúrgica.

Evaluation of the patient with leg edema

Leg edema is a common and challenging problem. The possible causes are numerous and are not limited to the vascular system. Bilateral swelling is usually a manifestation of systemic disorder, whereas unilateral swelling has many possible causes, the most common of which is chronic venous insufficiency. By means of the basic history and physical examination, a differential diagnosis can usually be established without extensive use of expensive diagnostic testing.

Surgical management of venous stasis disease: an update

The management of leg ulcers of venous origin begins with patient cooperation. Bed rest, leg elevation, and local care should relieve pain and initiate healing. This can be facilitated or managed on an outpatient basis by using an Unna's boot. Superficial varicosities should be ligated and stripped, and perforators identified by venography should be ligated and divided subfascially. Ulcers can then be excised and grafted. Long-term care includes chronic use of compression hose.

Relief of lymph obstruction by use of a bridge of mesentery and ileum

The background to the use of a bridge of ileum with its associated mesentery in the relief of lymphatic obstruction is described. A case report of the successful use of this method in a 22-year-old patient with lymphoedema praecox is presented. Following experience with further cases, it is suggested that, provided changes in the lymph channels and in the tissues of the affected limb are not irreversibly damaged, effective drainage through small gut lymphatics may be achieved.

Ulcers associated with the swollen leg

A number of disparate conditions may produce ulcers in swollen legs. The most frequent causative condition is venous stasis; other causal disorders are lymphatic obstruction, mixed vascular anomalies, benign and malignant neoplasms and a number of miscellaneous conditions. Careful attention to cutaneous signs of these conditions may be helpful in arriving at an accurate diagnosis and appropriate therapy.