Das geschwollene Bein in der gefäßmedizinischen Praxis

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

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