MISCELLANEOUS Unilateral Swelling of Right Lower Limb Siddhartha Sinha Ray Department of Physical Medicine and Rehabilitation, Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India Indian Journal of Physical Medicine & Rehabilitation (2020): 10.5005/jp-journals-10066-0086 A 16-year-old euthyroid, normotensive, non-diabetic female (Fig. 1) patient presented with unilateral right lower limb swelling for the last 11 months which was insidious in onset and gradually progressive in nature without any significant family history and past surgical history. She achieved pubarche at 14 years of age and menarche at 15 years. O/E:- There is non-tender pitting edema on the right lower limb extending just below her knees (Fig. 2). Further examination reveals positive Stemmer sign, no lymphadenopathy, or venous engorgement. Her LFT, urinary parameters were within normal limits. ANCA and anti-Ds DNA were negative. Venous Doppler ultrasound was also within normal limits. MRI shows mild thickening and enhancement of deep peripheral fascia surrounding the muscles in the right lower leg (Fig. 3). On radioisotope lymphoscintigraphy, there was a non-visualization of a lymphatic channel on the right leg (Fig. 4). So, she was diagnosed with a case of primary lymphedema—lymphedema praecox aka-Meig’s disease. Later on, she was treated with manual lymphatic drainage, intermittent pneumatic compression, and elevation, Faradism under pressure. Currently, she is doing well and fully independent on her ADL. © Jaypee Brothers Medical Publishers. 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Fig. 1: A 16-year-old female patient Fig. 2: Right lower limb swelling Fig. 3: MRI shows mild thickening and enhancement of deep peripheral fascia surrounding the muscles in the right lower leg
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MISCELLANEOUS
Unilateral Swelling of Right Lower LimbSiddhartha Sinha RayDepartment of Physical Medicine and Rehabilitation, Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
Indian Journal of Physical Medicine & Rehabilitation (2020): 10.5005/jp-journals-10066-0086
A 16-year-old euthyroid, normotensive, non-diabetic female (Fig. 1) patient presented with unilateral right lower limb swelling for the last 11 months which was insidious in onset and gradually progressive in nature without any significant family history and past surgical history. She achieved pubarche at 14 years of age and menarche at 15 years.
O/E:- There is non-tender pitting edema on the right lower limb extending just below her knees (Fig. 2). Further examination reveals positive Stemmer sign, no lymphadenopathy, or venous engorgement.
Her LFT, urinary parameters were within normal limits. ANCA and anti-Ds DNA were negative. Venous Doppler ultrasound was also within normal limits. MRI shows mild thickening and enhancement of deep peripheral fascia surrounding the muscles in the right lower leg (Fig. 3). On radioisotope lymphoscintigraphy, there was a non-visualization of a lymphatic channel on the right leg (Fig. 4). So, she was diagnosed with a case of primary lymphedema—lymphedema praecox aka-Meig’s disease. Later on, she was treated with manual lymphatic drainage, intermittent pneumatic compression, and elevation, Faradism under pressure. Currently, she is doing well and fully independent on her ADL.
1XXXXHow to cite this article: XXX, Unilateral Swelling of Right Lower Limb. XXXX 2020;XX(X):XX–XX.
© Jaypee Brothers Medical Publishers. 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Fig. 1: A 16-year-old female patient Fig. 2: Right lower limb swelling
Fig. 3: MRI shows mild thickening and enhancement of deep peripheral fascia surrounding the muscles in the right lower leg
Unilateral Swelling of Right Lower Limb
Indian Journal of Physical Medicine & Rehabilitation, Volume 31 Issue 2 (April–June 2020)50
Fig. 4: On radioisotope lymphoscintigraphy showing non-visualization of a lymphatic channel on the right leg with normal visualization in left leg
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