• Leg Swelling is very common
• Vein bulging is sometimes seen
• Sudden onset (less than 72 hrs.)

Deep Vein Thrombosis is a medical term for blood clots that form in the deep veins of your body, typically in the legs. The blood clots act like a dam, blocking the blood trying to get back to your lungs. The backed up blood results in warm swollen legs and a throbbing, "charley horse" type of pain. Your body will try to reroute blood flow around the blockage which may cause bulging of the open veins. All of this can happen quickly, usually within a day.

DVT is a common cause of leg swelling affecting at least 1 in 15 middle-aged adults in their lifetime.

Importantly, about half of the people with acute DVT develop Pulmonary Embolism (PE), a potentially life threatening event. In this situation the clot breaks loose and becomes lodged in the lungs. The blockage reduces oxygen in the blood, usually causing shortness of breath and chest pain. This is a serious event, with 10 to 30% of PE patients dying in the first month.

Since blood clots in the legs can become life threatening clots in the lungs, any unexplained sudden onset of leg swelling should be checked out. Seek medical attention if you have sudden leg swelling.

Signs and Symptoms

• Cramping or throbbing leg pain
• Warm, red, and swollen leg
• Enlarged surface veins may be present

Causes

• Recent surgery with normal inflammation and vein compression
• Prior DVT causing vein narrowing
• Poor leg movement with slow blood flow (leg cast, long periods of sitting or paralysis)
• Birth control pills or Hormone Replacement Therapy
• Genetic clotting disorders
• Cancer treatments or blood cancer
• Dehydration

Diagnosis and Treatment

Ultrasound is the best way to identify blood clots in the legs. CT is used to look for blood clots in the lungs.

Treatment usually involves blood thinners to stop new clots from forming. Other treatments are available for more severe blood clots.

• Leg Swelling is common
• Vein bulging is uncommon
• Sudden onset (less than 72 hours)

Cellulitis is an infection of the skin and underlying tissues. The exact cause of the infection is not always found.

Cellulitis can range from mild contained redness to severe painful limb swelling. Severe pain or severe swelling is a medical emergency.

Signs and Symptoms

• Pain, redness, and warmth are the typical findings of cellulitis.
• Pain, redness, and warmth are the typical findings of cellulitis.
• Fever and chills may be present.
• Vein bulging is not typically seen.

Causes

Any break in the skin can lead to cellulitis:

• Cuts, bites, puncture wounds, tattoos, piercings
• Chronic skin conditions including athlete’s foot and rashes
• Chickenpox and shingles sores
• Injections or IV drug use

Diagnosis and Treatment

• Cellulitis is typically diagnosed with a brief medical exam.
• Additional tests are not usually needed in simple cellulitis.
• Oral antibiotics are used for mild infections, IV antibiotics for more severe infections.
• Patients who have had multiple infections below the knee should be checked for fungal infections such as athlete’s foot, which can cause tiny breaks in the skin.
• Diabetics are a high risk group due to skin changes that make it harder to fight off skin infections.

• Leg Swelling is very common
• Vein bulging is common
• Slow onset

Typically results from broken one-way valves in the leg veins. The result is backwards blood flow and pooling of blood in the legs. It is usually noticed as leg swelling and a dull aching leg pain which worsens through the day. Varicose veins are common.

Take the Venous Insufficiency self-test to see if you might have this disease

Signs and Symptoms

• Varicose veins, spider veins
• Leg swelling
• Skin darkening
• Cramping pain
• Aching pain relieved with leg elevation
• Heaviness sensation in the legs and feet
• Legs feel better when reclining, lifted up above the waist level.
• Legs feel worse when standing.

Risk Factors

• Family history of vein disease
• Standing or sitting for long periods of time
• Pregnancy, especially multiple
• Older age
• Inactive lifestyle
• Obesity
• Calf muscle problems

Diagnosis and Treatment

• Ultrasound + brief physical exam are used for diagnosis.
• Treatment typically requires closure or removal of the diseased vein.
• Non-surgical treatment includes weight loss and exercise. Compression stocking therapy only relieves symptoms, and does not treat the underlying disease.
• Medications: Diosmiplex (Vasculera) is the only FDA approved prescription medicine for vein treatment.
• Horse chestnut seed extract is non-prescription, and has been shown to be helpful.
• Other medications have received good reviews as well. But please keep in mind that medications are only a temporary treatment. Vein disease is like a tooth cavity - it just gets worse until no medicine helps. Direct treatment of the veins is ultimately needed.

• Leg Swelling is common
• Vein bulging is uncommon
• Onset usually within few days of starting the new medicine

Corticosteroids/Prednisone

• Estrogen
• Progesterone
• Testosterone
• Clonidine
• Hydralazine
• Minoxidil
• Methyldopa

Calcium channel blockers - 50% incidence in some studies

• Amlodipine (Norvasc) - 10% incidence
• Diltiazem (Cardizem, Tiazac, others)
• Felodipine
• Isradipine
• Nicardipine
• Nifedipine (Adalat CC, Procardia)
• Nisoldipine (Sular)
• Verapamil (Calan, Verelan)

Beta blockers

• Nadolol (Corgard)
• Penbutolol (Levatol)
• Pindolol (Visken)
• Propranolol (Inderal, Inderal LA, Betachron, InnoPran)
• Sotalol (Betapace, Sorine)
• Timolol (Blocadren, Timolide, Betimol, Istalol, Timoptic)
• Acebutolol (Sectral)
• Atenolol (Tenormin)
• Betaxolol (Kerlone)
• Bisoprolol (Zebeta)
• Esmolol (Brevibloc)
• Metoprolol succ. (Toprol XL)
• Metoprolol tart. (Lopressor)
• Carvedilol (Coreg, Coreg CR)
• Labetalol (Normodyne, Trandate)
• Nebivolol (Bystolic)

NSAIDs - 5% incidence in some studies

• Monoamine oxidase inhibitors
• Rosiglitazone
• Pioglitazone
• Gabapentin - 8% incidence
• Thiazolidinediones, Avandia and Actos
• SSRIs
• Diet Drugs
• Methamphetamines
• Lithium
• Amiodarone
• Chemotherapy medications

• Leg Swelling is common
• Vein bulging is common
• Slow onset

Found in women of childbearing age, this disease is characterized by pelvic pain that results from pooling of blood in the pelvis due to vein blockage or poor flow. Bulging veins in the groin are common, as is leg swelling.

Signs and Symptoms

• Chronic pelvic pain or low back pain lasting more than 6 months.
• Pain worsened by standing or sexual intercourse.
• Pain improved with lying down.
• Pain usually more on one side than the other, and may go into the leg.
• Abnormal menstrual bleeding is sometimes seen.

Risk Factors

• Women aged 20 to 45 years
• Multiple childbirths
• History of blood clots

Diagnosis and Treatment

Ultrasound is usually needed to diagnose pelvic venous flow disorder. Treatment usually involves minimally invasive treatment of the veins.

Some doctors treat patients simultaneously with high-dose medroxyprogesterone acetate, NSAIDs, and GnRH agonists.

• Leg Swelling is very common
• Vein bulging is variable depending on the cause
• Slow onset

Typically painless, lymphedema is a build up of fluid in the skin. In the early stages lymphedema is usually noticed as skin squishiness, or "pitting". After months of lymphedema, the skin usually thickens and becomes hard and rough.

Causes

The lymphatic system normally drains fluid out of swollen legs, so lymphatic disease or lymphatic overload can lead to lymphedema.

Specific causes:

• Vein disease causing fluid seepage from leaky or thin walled veins.
• Cancer may narrow or block lymphatics
• Surgical removal of lymph nodes may cause lymphedema
• Radiation treatment with inflammation or scarring of lymphatics
• Infection of lymph nodes by parasites (seen in developing countries).

Diagnosis and treatment

• Lymphedema can usually be diagnosed after a complete checkup with basic blood tests to exclude other diseases.
• A team approach to treatmentis strongly recommended.
• Treatment includes exercise, leg elevation, compression garments, physical therapy, and pneumatic compression devices.
• Lymphedema is a chronic disease. Lifelong support is important.

• Leg Swelling is very common
• Vein bulging is uncommon
• Slow onset

Lipedema is a painful enlargement of the legs due to build-up of fat beneath the skin. The legs stay fat even after weight loss. Lipedema is common, affecting about 1 in 10 women. The cause of lipedema is unknown, but many suffering from this disease have a family history of lipedema, suggesting that part of this disease is inherited. The disease usually starts after hormonal changes such as puberty, pregnancy or menopause.

Signs and Symptoms

• The skin over the enlarged legs usually looks normal, but it may lose its stretchiness.
• Pain and easy bruising are common due to the fragile nature of the small blood vessels within the fat tissue.

Diagnosis and Treatment

• Lipedema is difficult to evaluate and diagnose, and is best done by doctors who have expertise in this disorder. For example, the skin may be tested for high levels of sodium.
• There is no single effective treatment for lipedema, but treatment typically includes Complete Decongestive Therapy (also called complex decongestive therapy, or CDT). CDT combines several approaches including manual lymph drainage (a message technique), compression therapy, and physical therapy.
• Additional management includes exercise, diet and nutritional support.
• Surgery may be considered if conservative and supportive therapies are not effective.
• There should be periodic evaluation for other new causes of leg swelling.
• Emotional support is important through all stages of therapy and management. On-line support groups are suggested.

• Leg Swelling is very common
• Vein bulging is variable
• Slow onset

Idiopathic Edema is also known as fluid-retention edema, and occurs only in menstruating women.

Signs and Symptoms

Typically, there is severe fluid retention with a weight gain of greater than 3 pounds by the end of the day. The end result is swelling of the legs, face and hands. The cause is not well defined.

Diagnosis and Treatment

• Testing includes morning and evening weights; nude and with an empty bladder before food or fluids in the morning and again at bedtime. An average weight gain of more than 1.5 pounds is consistent with idiopathic edema. The diagnosis is then usually made in the doctor's office after a good history and physical examination. Additional tests are only needed when there is a question about the diagnosis.
• Treatment is well defined. Spironolactone is considered the drug of choice. Other management includes leg elevation, avoiding hot environments, low-salt diet, avoiding excessive fluids, and weight loss for obese patients.
• Idiopathic edema should be distinguished from premenstrual edema.
• Depression, obesity and diuretic abuse are frequently seen with this disease. It is important to let your doctor know if this sounds like you. The disease is treatable.
• Compression stockings are usually not helpful and not tolerated.

• Leg Swelling is common
• Vein bulging is uncommon
• Slow onset

Sleep apnea is a disorder in which breathing stops and starts repeatedly during the night. In the early stages, there is poor sleep and daytime sleepiness. In the later stages, the poor breathing and low blood oxygen causes a strain on the heart. The result is poor circulation with pooling of blood in the calves and swelling of the legs.

Sleep apnea is common, with an estimated 1 in 5 adults having mild sleep apnea and 1 in 15 having moderate disease. Take the STOP-Bang self-test to see if you are at risk for sleep apnea.

Take the STOP-Bang Test

Signs and Symptoms

• Early symptoms of sleep apnea include leg swelling, which is the first symptom noticed by about 10% of patients.
• Daytime sleepiness and foggy, unclear thinking are very common.
• Later stages of sleep apnea can result in heart strain and heart attacks.

Causes

Low oxygen levels in the blood causes a strain on the heart. In the later stages it can lead to heart failure, with poor circulation in the legs and pooling of blood in the calves.

Diagnosis and Treatment

Diagnosis is best managed by a sleep disorder specialist. Different types of sleep apnea need different treatments.

• Leg Swelling is common
• Vein bulging is uncommon
• Slow onset

A simple way to describe pulmonary hypertension is chronic lung disease from various causes. With chronic lung disease the lungs scar-down, making it hard for the heart to pump blood through the lungs. As the heart strains to get blood through the lungs it can become damaged. The heart no longer pumps well. Ultimately, there is poor circulation through the whole body, including the legs. Poor circulation in the legs results in blood pooling and leg swelling.

Signs and Symptoms

• Tiredness and shortness of breath just when exercising but eventually even when resting.
• Skin may look pale or slightly blue.
• Chest pain or pressure are common.
• As the heart fails, there is swelling in the ankles, legs and eventually throughout the body.

Causes

• Chronic or recurrent blood clots plugging up the lungs
• Many thick blood blood diseases (polycythemia, thrombocythemia)
• Lung disease such as COPD or emphysema
• Pulmonary fibrosis from unknown cause
• Drugs: Diet, some anti-depressant, and illegal drugs
• Heart muscle or valve disease hurting the lungs
• Chronic infection with lung scarring
• Additional causes are listed in the Doctors Toolbox

Diagnosis and Treatment

• Diagnosis may be difficult due to the slow progression of disease.
• An heart ultrasound is recommended in patients who are at risk for pulmonary hypertension and in any patients over age 45 with leg swelling of unclear cause. Any additional management should be overseen by a pulmonary specialist.

• Leg Swelling is uncommon
• Vein bulging is uncommon
• Slow onset

The thyroid gland in your neck is responsible for making thyroid hormone which controls the metabolic speed for your entire body. Low levels of thyroid hormone is called Hypothyroidism. Severely low levels can lead to leg swelling. Fortunately, this is not common in developed countries.

Signs and Symptoms

There is characteristic swelling around eyes, hands, and feet. Additionally, there is swelling of the mouth and throat, which results in a thick slurred speech and hoarseness.

Diagnosis and Treatment

It is often possible to diagnose hypothyroidism in the doctor's office. Typical findings are:

• Swelling of feet, hands, and around eyes
• Hoarse voice
• Brittle, sparse hair
• Mental and physical slowness, weakness
• Depression or Confusion
• Dry skin
• Weight gain
• Feeling cold all the time
• Constipation
• Thyroid gland enlargement (Goiter)
• Low blood pressure and heart rate
• Blood tests are used to confirm the diagnosis. The thyroid hormone is replaced in a pill.

• Leg Swelling is common
• Vein bulging is uncommon
• Slow onset

With heart failure, the heart loses its ability to pump blood effectively. As a result, blood tends to pool in the lower legs, causing swelling.

Signs and Symptoms

• Chest pain is the most common symptom of heart disease. But the amount of the pain does not always match with the severity of disease, especially in diabetics, women and the elderly who may have little or no chest pain. Instead, they are more likely to complain of tiredness, shortness of breath and grayish skin color when exercising.
• Leg swelling is common. As heart failure worsens there is fluid buildup and swelling throughout the body.
• Fluid buildup in the lungs results in coughing, wheezing or shortness of breath. These patients are at risk for pneumonia.

Diagnosis and Treatment

Any new or unexplained chest pain should be checked out. Severe chest pain should be considered a heart attack until proven otherwise, and is a medical emergency.

• Leg Swelling is common
• Vein bulging is common
• Slow onset

Liver disease leads to liver scarring, also called cirrhosis. A scarred-down liver acts like a dam to blood flow, causing a back-up of fluid in the abdomen and legs.

Signs and Symptoms

• Yellowish skin and whites of the eyes (jaundice)
• Swelling of the abdomen and legs
• Bruising easily with frequent nosebleeds
• Vein bulging
• Itchiness
• Kidney issues
• Gallstones

Causes

• Chronic alcoholism
• Viruses, such as hepatitis A, hepatitis B, and hepatitis C
• Drug reactions or drug abuse
• Liver cancer
• Inherited diseases, such as hemochromatosis and Wilson's disease

Diagnosis and Treatment

• Your doctor will typically get a diagnosis with an office visit and blood tests. Ultrasound or CT of the abdomen may be performed to look at the liver and any bulging blood vessels around the liver.
• A team approach to management is typically required to treat the medical and social parts of this disease.

• Leg Swelling is common
• Vein bulging is uncommon
• Onset variable

The kidneys are responsible for getting rid of extra body fluid through the urine while keeping the blood balanced. When the kidneys are diseased there is typically a buildup of fluid in the body with swelling of the legs.

Signs and Symptoms

• Swelling around the eyes, most severe in the morning
• Swelling of the legs
• Physical slowness and tiredness
• Mental slowness
• Poor appetite
• Difficulty sleeping
• Muscle cramps
• Dry, itchy skin

Causes

• Diabetes
• High blood pressure
• Allergies or drug reactions
• Severe or multiple kidney infections
• Inherited diseases, such as polycystic kidney disease
• Urine obstruction or backwards flow
• Autoimmune diseases such as Lupus

Diagnosis and Treatment

As there are many potential causes for kidney disease, the goal is to identify and treat the underlying cause. This is followed by protecting the kidneys from further injury. Diabetes, hypertension and other chronic diseases should be managed by an experienced medical team familiar with the patients needs.

• Leg Swelling is common
• Vein bulging is uncommon
• Slow onset

Complex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy (RSD), is a condition that typically causes severe pain and limb swelling after injury or surgery.

Signs and Symptoms

• Severe pain much greater than expected after injury or surgery
• Severe burning or squeezing pain
• Severe pain that spreads from a single point on the affected extremity
• Continuous pain that gets worse over time
• Extreme sensitivity to touch resulting in severe pain
• Pain that travels to the opposite side
• Skin swelling
• Skin changes days-to-weeks; warm, swollen and tender, with increased sweating
• Skin changes weeks-to months; skin is thin, shiny and cool
• Skin changes months-to-years; dry, with severe skin tightening

Causes

Not well understood, but thought to be a result of hyperactive pain nerves after injury. Genetics and allergies may be involved in the cause of this disease.

Diagnosis and Treatment

CRPS is typically diagnosed through detailed history and physical examination. Important clues for diagnosis include recent soft tissue injury, fracture or surgery. Various additional tests are available for confirmation.

Early treatment is important since the earlier stages of disease respond better to treatment.

Medications typically used:

• Skin anestheticssuch as lidocaine or EMLA cream
• Antidepressants
• NSAIDs
• Anti-seizure medications may help to treat the pain
• Steroids such as prednisolone to treat swelling
• Nasal spray that treats bone loss
• Nerve blocking injections
• Opioids

Interventions include:

• Stimulating electrodes
• Physical therapy
• Psychotherapy and behavioral pain management tools
• Splints and braces to help manage pain and contractures
• Surgical nerve blocks for severe disease