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Swollen Leg Frequently Caused By Deep Vein Thrombosis
A DGReview of :"The swollen leg: is it deep vein thrombosis? The experience of a tertiary referral center in Sri Lanka"
Ceylon Medical Journal
07/12/2002
By Anne MacLennan
Deep vein thrombosis is the cause of swollen legs in some 45 percent of patients referred to a specialist centre in Sri Lanka.
Until now, the contribution of deep vein thrombosis (DVT) to this condition in Sri Lanka has been unknown and believed to be insignificant. This report from the Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, is the first to investigate this issue.
Drs S M Wijeyaratne and A H Sheriffdeen underline the study does not reflect the true prevalence of DVT in the general community. The patients were a selected sample of DVT suspects from among patients with swollen legs who presented to hospital and community doctors.
At the same time, however, the findings point to DVT as being seen by doctors more as an afterthought than a condition needing to be actively excluded early on.
In this prospective study, doctors examined consecutive patients referred to the University Surgical Unit from January through October 1998. People with varicose veins, leg ulceration and generalized oedema were excluded.
Color duplex scanning of the proximal deep veins and the superficial veins was used to detect occlusion and reflux, and information on previous diagnoses and treatment were obtained from patients' medical records.
Overall, 63 of 137 (45 percent) patients had deep venous causes for oedema. Fever with rigors and inguinal lymphaedenopathy were strongly predictive of non-DVT causes.
Among outpatients, filariasis was found to be the first diagnosis. DVT was considered late.
Indeed, these authors suggest emphasis on filariasis as the cause of leg swelling seems excessive and underline a change is required in the approach to the swollen leg management in Sri Lanka.
Drawbacks related to diagnosis could be corrected by an increased awareness of the value of certain clinical features, the relevance of risk factors and better utilization of available ultrasound equipment.
Further research needs to estimate the prevalence of DVT among high-risk groups with a view to adopting strategies for prophylaxis.
Finally, these authors conclude, more than half the thromboses among outpatients were spontaneous; thus genetic and autoimmune causes need to be researched.
Ceylon Medical Journal Vol. 47, No. 1, March 2002.
"The swollen leg: is it deep vein thrombosis? The experience of a tertiary referral center in Sri Lanka"
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