Diagnostic Tests for Leg swelling

Diagnostic Test list for Leg swelling:

The list of diagnostic tests mentioned in various sources as used in the diagnosis of Leg swelling includes:

• Physical examination
  • Temperature
  • Inspect legs for size and symmetry, any bruises, swellings, discoloration, ulcers or rashes If swelling is due to edema , is it pitting(skin is indented when pressure is applied) or non- pitting - can assist in determining cause of edema (swelling) e.g. bilateral pitting edema occurs in heart failure, cirrhosis of the liver, nephrotic syndrome, malabsorption form the gastrointestinal tract; unilateral pitting edema occurs in deep venous thrombosis and with compression of large veins by pelvic tumor or lymph nodes; non-pitting edema occurs in hypothyroidism and lymphedema.
  • Signs of edema - If swelling is due to edema ,examine for signs of possible causes such as congestive cardiac failure , liver cirrhosis , nephritic syndrome, deep venous thrombosis , hypothyroidism and varicose veins (e.g. examine for enlarged liver which may suggest cirrhosis or cardiac disease; ascites (accumulation of fluid in the abdominal cavity) along with enlarged liver would suggest cirrhosis of the liver or constrictive pericarditis; enlarged liver without ascites would suggest congestive cardiac failure.
  • Feel the leg for local causes of swelling, pain and tenderness
  • Examine for signs of acute lower limb ischemia (sudden obstruction of arterial blood supply from thrombosis (clot) or embolism (plug) - e.g. pitting edema of foot, absent pulses, cool pale skin, loss of hair on lower feet and legs, ulcers on foot, gangrene of skin on toes.
  • Examine the lymph nodes in groin which may be enlarged with leg cellulitis
• Blood tests
  • Full blood count and ESR
  • Renal function tests
  • Electrolytes
  • Liver function test can diagnose cirrhosis and hypoalbuminaemia which may be a cause of ankle and lower leg edema
  • Thyroid function tests
  • Serum protein electrophoresis
  • If recurrent DVT or family history of thrombosis test for antithrombin III, protein S and protein C deficiency
  • D-dimer testing is a sensitive indicator of active deep venous thrombosis
  • Blood cultures, if suspect cellulitis or osteomyelitis
• Urine tests
  • Increased protein in urine can help detect Nephrotic syndrome
  • Abnormal urinary sediment may suggest nephritis due to glomerulonephritis, diabetes mellitus or a collagen disease
• Radiological examination
  • X-ray of leg
  • Chest X-Ray looking for signs of congestive cardiac failure
  • Echocardiogram to determine left ventricular ejection fraction, if suspect congestive cardiac failure as cause of bilateral pitting edema
  • CT Scan of chest, if suspect constrictive pericarditis
  • CT Scan of abdomen and pelvis, if suspect compression of large veins by abdominal tumor
  • Contrast lymphangiography, if suspect lymphedema
  • Bone scan may be needed to diagnose osteomyelitis or obscure fractures
• Vascular tests
  • Duplex ultrasound scan - can detect deep venous thrombosis and measure blood flow in peripheral vascular disease.
  • Venous pool radionuclide scan - can help diagnose deep venous thrombosis.
  • Contrast venography - can help diagnose deep venous thrombosis if duplex ultrasound scan and radionuclide scan are negative.
• Electrocardiogram

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