Answers
1) The picture shows
- The whole left leg is swollen
- Presence of scar at the anterolateral part of the left shin
- Deformity of the left leg
- Skin hypertrophic especially over the left ankle
- Loss of hair around the leg
2) Differential diagnosis of unilateral leg swelling
- Deep vein thrombosis
- Chronic venous insufficiency
- Filariasis
- Cellulitis
- Acute compartment syndrome
- Fracture tibia/ fibula
- Lymphangitis
- Ruptured baker cyst
- Ruptured medial head of gastrocnemius
- Reflex sympathetic dystrophy
- Pelvic tumor or mass compressing the veins.
3) Left leg filariasis
4) Further question to ask
a) Nature of the swelling (painful, disfiguring swelling of leg)
b) swelling of other part of body especially external genital organ)
c) Complication of the disease (elephanitis related blindness)
d) Living in area epidemic of filariasis especially place with stagnant water with Water Hyacinth/ Eichhornia crassipes (keladi bunting)
5)
causative organism: Filarial worm (Wuchereria bancrofti, Brugia malayi or Brugia timori)
Vector: Aedes, Anopheles, Culex, or Mansonia
6) Investigation to confirm the diagnosis
-Serum ELISA for Filarial antigen
- Detection of microfilariae in blood
- Detection of filarial antibody
- Ultrasound for venous obstruction of visualization of worm
7) Management
- It should be managed by multi disciplinary approach (internal medicine, urologist, ophthalmologist, general surgeon, plastic surgeon)
- Bed rest, limb elevation and compression bandage to relieve the edema
- Analgesic
- Anti dilarial drugs (Diethyl carbamazine citrate with albendazole or ivermectin and albendazole)
- Surgical management for hydrocele or to relieve the lymph obstrution.
- Skin care and exercise to increase lymphatic drainage
- Skin care to prevent secondary skin infection in case of elephanitis due to crack skin.
- Fat food restriction in patient with chyluria
- Plastic reconstruction of the leg