|
|
| Línea 1: |
Línea 1: |
| Swollen extremity is a common ED presentation requiring evaluation for dangerous vascular, infectious, and musculoskeletal causes.
| | #REDIRECT[[Unilateral_leg_swelling]] |
| | |
| ==Differential Diagnosis==
| |
| ===Unilateral Upper or Lower Extremity===
| |
| *[[Deep venous thrombosis]]
| |
| *[[Cellulitis]] / soft tissue infection
| |
| *[[Abscess]]
| |
| *[[Compartment syndrome]]
| |
| *Fracture
| |
| *[[Septic arthritis]]
| |
| *Baker cyst rupture (posterior knee)
| |
| *Lymphedema (post-surgical, radiation)
| |
| *Venous insufficiency
| |
| *Post-thrombotic syndrome
| |
| | |
| ===Bilateral Lower Extremity===
| |
| *[[Congestive heart failure]]
| |
| *Venous insufficiency (chronic)
| |
| *Nephrotic syndrome
| |
| *Cirrhosis
| |
| *Medication-related (CCBs, NSAIDs)
| |
| *[[Hypothyroidism]]
| |
| *[[Preeclampsia]] (in pregnancy)
| |
| | |
| ===With Pain and Erythema===
| |
| *[[Cellulitis]]
| |
| *[[Necrotizing fasciitis]] - surgical emergency
| |
| *[[Gout]] / [[Pseudogout]]
| |
| *[[Septic arthritis]]
| |
| *[[DVT]]
| |
| *[[Compartment syndrome]]
| |
| | |
| ==Evaluation==
| |
| *Assess for red flags: pain out of proportion, crepitus, rapidly spreading, hemodynamic instability
| |
| *Compare to contralateral extremity
| |
| *Unilateral leg swelling: apply Wells criteria, obtain D-dimer or compression [[DVT ultrasound|ultrasound]]
| |
| *If infection suspected: CBC, BMP, lactate, blood cultures if septic
| |
| *Compartment pressures if compartment syndrome suspected
| |
| *Joint aspiration if septic arthritis on differential
| |
| *X-ray if fracture suspected
| |
| | |
| ==Management==
| |
| *DVT: [[Anticoagulation]] per protocol
| |
| *Cellulitis: [[Antibiotics]] (see [[Skin and soft tissue antibiotics]])
| |
| *Necrotizing fasciitis: emergent surgical consultation, broad-spectrum antibiotics
| |
| *Compartment syndrome: emergent fasciotomy
| |
| *Heart failure: [[Furosemide]], treat underlying cause
| |
| | |
| ==Disposition==
| |
| *Admit for necrotizing fasciitis, compartment syndrome, septic arthritis, or sepsis
| |
| *Admit for severe cellulitis requiring IV antibiotics
| |
| *Consider admission for proximal DVT in high-risk patients
| |
| *Discharge with close follow-up for uncomplicated DVT on anticoagulation
| |
| *Discharge with PCP follow-up for bilateral edema with stable vitals
| |
| | |
| ==See Also==
| |
| *[[Deep venous thrombosis]]
| |
| *[[Cellulitis]]
| |
| *[[Compartment syndrome]]
| |
| *[[Unilateral leg swelling]]
| |
| *[[Edema]]
| |
| | |
| ==References==
| |
| <references/>
| |
| | |
| [[Category:Symptoms]]
| |
| [[Category:Orthopedics]]
| |
