Abstract
In case of an acute leg swelling a deep leg vein thrombosis needs to be excluded.
In order to do this, compression sonography and the D-dimer-test are applied in the
framework of an established diagnostic algorithm. The ensuing therapy consists in
anticoagulation and compression.
In case of a chronic leg swelling anamnesis and a clinical check-up often lead to
a differential diagnosis. Chronic venous insufficiency is a generic term for a disturbed
venous backflow. It is caused by an obstruction or an antegrade or retrograde flow
insufficiency. Most common diseases in this context are varicosis or a post-thrombotic
syndrome. Sonography and special function tests provide a diagnosis. The basic therapy
consists in regular exercise, normalization of weight and compression therapy. In
case of a hemodynamically relevant varicose vein surgery or endovascular treatment
is advisable. The post-thrombotic syndrome must be treated consistently with the basic
therapy.
A lymphedema may be hereditary or acquired. In a first step diseases like neoplasia
need to be excluded. The initial therapy consists in manual lymph drainage in combination
with special compression bandages. Flat knit stockings should be prescribed. Surgical
treatment is reserved for special circumstances.
A lipedema is clinically diagnosed. It is characterized by lipohypertrophia, pressure
sensitivity of the tissue and susceptibility to hematomas. Treatment options include
weight reduction, regular exercise, lymph drainage and compression therapy, in some
cases liposuction.
Das Symptom Beinschwellung ist in der allgemeinmedizinischen Praxis häufig – dahinter
können sich akute oder chronische Krankheitsbilder verbergen. Anamnese und körperliche Untersuchung
liefern richtungsweisende Informationen. Dieser Beitrag gibt einen Überblick über
die wichtigsten Differenzialdiagnosen und widmet sich dann den angiologischen Krankheitsbildern,
deren Diagnostik und Therapie zusammen mit dem Gefäßmediziner erfolgen.
Schlüsselwörter
geschwollenes Bein - tiefe Beinvenenthrombose - chronisch-venöse Insuffizienz - Lymphödem
- Lipödem
Key words
swollen leg - deep leg vein thrombosis - chronic venous insufficiency - lymphedema
- lipedema
