I had a patient once, an adult, who had a large uterine fibroid that
actually impinged on venous return and gave LE swelling... I don't know
if that was a rarity and can't remember details but perhaps some
investigation into venous return system proximal to the LE (ie. pelvic)
might be useful?
Pedi ER fellow
On Wed, 5 Sep 2001 09:41:50 -0700 tom langston <[log in to unmask]>
>I am curious as to what the group could suggest as a
>possible diagnosis for this patient:
> 13 y.o. Ethiopian female with 3 day h/o
>atraumatic, acute onset of R LE swelling...from the
>thigh down to ankle. Prior to arrival to the ED the
>patient had an ultrasound of LE which was neg for DVT.
>There is no hx of travel. The patient was last in
>Ethiopia 2 yrs ago. First onset of menses began 4
>days prior to presentation. Other than the swollen
>extremity , there are no other complaints.
> On presentation, vitals were stable, afebrile. The
>patient is well appearing, in NAD. RLE markedly
>swollen with a 3 inch increase in diameter from thigh
>to ankle as compared with the LLE. No pitting edema.
>The leg is nontender, not warm to touch. The patient
>can ambulate without pain or difficulty. The rest of
>the physical exam was normal.
> CT of the abdomen and pelvis were normal, as were
>filarial studies. CBC was normal as well. Total
>protein was high at 8.1.
>Tom Langston, MD
>The early bird may get the worm....but the second mouse gets the
> -Guy Clark
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