virgola82
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A 22 yo woman complains of swelling of her right lower extremity. The swelling has started 2 years ago and has been slowly progressive. There is no pain, no history of trauma, and no family history of a similar problem. She is otherwse healthy and currently is taking no medication. PE is notable for grade 2 firm edema involving the right thigh, calf, foot and toes. Results of the examination are otherwise normal. What is the most appropriate next step in the management of this patient?
A. A graduated elastic support stocking (20-30 mmHg strength)
B. Furosemide
C. Duplex ultrasonography of the lower extremity veins
D. Lymphoscintigraphy and CT of abdomen and pelvis
E. Warfarin thearpy
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| suv
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D?
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| elitoki
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D.
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| Justice
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D. Lymphoscintigraphy and CT of abdomen and pelvis
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| dr_arc
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D
lymphangioscintigraphy to inv the lymph edema and i guess the CT is to look for some occult malignancies in the abdomen,though the gradual onset and lack of any other feature is more likely to make it a benign lymphedema.
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| mytime
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| dr in trouble
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| virgola82
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Right, this pt most likely has lymphedema praecox that affects most commony women younger than 40 yo. To diagnose it it's necessary to exclude other causes, like pelvic abnormalities, therefore PAP smear, pelvic exam and abdominopelvic CT are required. The diagnosis is then confirmed noninvasively by lymphoscintigraphy. The treatment is based on edema reduction techniques + graduated eastic compression hose, weight reduction if obese and antifungal therapy to prevent tinea pedis. Abx are needed only if cellulitis develops
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