Ver el código de «Unilateral leg swelling»

==Background==
*Unilateral leg swelling is a common ED complaint<ref>Markarian B, et al. Assessment Modalities for Lower Extremity Edema, Lymphedema, and Lipedema: A Scoping Review. Cureus. 2024 Mar;16(3):e55906. PMID 38601427</ref>
*The critical EM concern is ruling out [[deep vein thrombosis]] (DVT), which can lead to [[pulmonary embolism]]<ref>Schellong SM, et al. [Leg swelling]. Internist (Berl). 2013 Nov;54(11):1294-303. PMID 24264570</ref>
*Other important causes include [[cellulitis]], [[compartment syndrome]], ruptured [[Baker's cyst]], and [[necrotizing fasciitis]]
*Further classified as pitting (compressible) and non-pitting (lymphedema, myxedema)
{{Causes Pedal Edema}}

==Clinical Features==
===History===
*Onset: acute (DVT, cellulitis, compartment syndrome) vs. chronic (venous insufficiency, lymphedema)
*Pain: DVT (calf tenderness), cellulitis (diffuse), compartment syndrome (severe, out of proportion)
*Skin changes: erythema, warmth, skin break, ulceration
*Recent surgery, immobilization, travel, hospitalization, malignancy (DVT risk factors)
*History of DVT/PE
*Fever (infection)
*Trauma (compartment syndrome, fracture)

===Physical Exam===
[[File:PedalEdema.jpg|thumb|Pitting pedal edema]]
*Measure and compare calf circumferences (>3cm difference is significant)
*Assess for pitting vs. non-pitting edema
*Skin: erythema, warmth, crepitus, bullae, ecchymosis, skin breaks
*Palpate pulses (arterial disease)
*Assess compartments for firmness, pain with passive stretch (compartment syndrome)
*Homan sign (calf pain with dorsiflexion) — poor sensitivity and specificity, not reliable

===Red Flags===
*[[Compartment syndrome]]: pain out of proportion, tense swelling, pain with passive stretch, paresthesias
*[[Necrotizing fasciitis]]: pain out of proportion, crepitus, rapidly spreading erythema, systemic toxicity
*Phlegmasia cerulea dolens: massive DVT with cyanotic, severely swollen limb, risk of limb loss

==Differential Diagnosis==
{{Unilateral leg swelling DDX}}

==Evaluation==
===DVT Assessment===
*Apply Wells criteria for DVT pretest probability
**Low probability: obtain [[D-dimer]]; if negative, DVT effectively excluded
**Moderate/high probability: proceed directly to [[DVT ultrasound|compression ultrasound]]
*[[DVT ultrasound]] (compression ultrasound) is the diagnostic study of choice
**Sensitivity >95% for proximal DVT
**If negative but clinical suspicion remains high, consider repeat in 5-7 days or whole-leg ultrasound

===Infection Assessment===
*[[CBC]] with differential, [[BMP]]
*Blood cultures if systemic signs of infection or concern for bacteremia
*[[Lactate]] if concern for [[sepsis]] or [[necrotizing fasciitis]]
*Consider CT or MRI if deep space infection or abscess suspected
*X-ray if concern for gas in soft tissues ([[necrotizing fasciitis]], gas gangrene)

===Other===
*[[Knee X-ray]]: if trauma or concern for fracture
*POCUS: assess for DVT at bedside, popliteal (Baker's) cyst
*Consider CT venography if ultrasound nondiagnostic and clinical suspicion high
*Compartment pressures if [[compartment syndrome]] suspected (or clinical diagnosis if classic findings)

==Management==
===DVT===
*Anticoagulation: see [[Deep vein thrombosis]] for detailed management
*Elevation, analgesia
*Emergent vascular surgery consultation for phlegmasia cerulea dolens (may need catheter-directed thrombolysis or thrombectomy)

===Cellulitis===
*Antibiotics based on severity (see [[Cellulitis]])
*Outpatient oral antibiotics for uncomplicated
*IV antibiotics for systemic signs, failed outpatient therapy, or immunocompromised

===Compartment Syndrome===
*Emergent surgical consultation for fasciotomy
*Remove all constrictive dressings/casts
*Do not elevate above heart level

===Necrotizing Fasciitis===
*Emergent surgical debridement
*Broad-spectrum IV antibiotics
*See [[Necrotizing fasciitis]]

===Baker's Cyst Rupture===
*Conservative management: rest, elevation, NSAIDs, compression
*Must rule out DVT (can coexist)

==Disposition==
===Admit===
*Proximal DVT with hemodynamic compromise or phlegmasia
*[[Compartment syndrome]] (to OR)
*[[Necrotizing fasciitis]] (to OR)
*Cellulitis requiring IV antibiotics
*Sepsis from lower extremity source

===Discharge===
*Uncomplicated DVT: can be managed outpatient with anticoagulation if reliable patient and adequate follow-up
*Uncomplicated cellulitis responding to oral antibiotics
*Baker's cyst rupture with DVT excluded
*Chronic venous insufficiency: compression stockings, elevation, outpatient follow-up
*Return precautions: worsening swelling, increasing pain, shortness of breath or chest pain (PE concern), fever, skin color changes

==See Also==
*[[Deep vein thrombosis]]
*[[Bilateral leg swelling]]
*[[Cellulitis]]
*[[Compartment syndrome]]
*[[Necrotizing fasciitis]]

==External Links==
*[http://ddxof.com/lower-extremity-edema/ DDxOf: Differential Diagnosis of Lower Extremity Edema]

==References==
<references/>

[[Category:Cardiology]]
[[Category:FEN]]
[[Category:Symptoms]]