Swelling of a Leg

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When one considers the symptom of leg swelling in the context of travel to a tropical destination, the memory of photographs such as the one to the right often comes to mind. This photograph shows a patient who is a life-long resident of tropical village. He has a parasitic infection called filariasis that is acquired by the bite of an infected mosquito. Over many years, the untreated parasitic infection has caused blockage of the lymph flow from the leg and recurrent -- and eventually permanent -- swelling of an extremity (i.e., elephantiasis).

This condition is not rare in the proper geographic and socioeconomic context. However, it is exceedingly rare among travelers and can usually be diagnosed and treated before any permanent damage accrues. In fact, as a traveler from the U.S. to the tropics, this infection should be last, not first, concern if you should develop leg swelling during or after travel. It is mentioned here first, because there is often an unwarranted fear about these infections, and thoughts about them are --as the saying goes -- "the elephant in the room."


Source: Dr. Steven A. Williams, 2005. PLoS Biol 3/4/2005: e148.

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Deep Vein Thrombosis

This problem is a much more common and more urgent problem than filariasis in recent travelers. A deep vein thrombosis (DVT) is a blood clot that develops in a leg vein. It often causes swelling of one leg -- the kind that will allow you impress a thumbprint over an ankle. There may be pain (particularly with walking), tenderness of the calf or thigh, and redness over the involved area. Depending on their position in the vessels of the leg, some DVTs may present a danger and require prompt diagnosis and treatment.

DVT may occur after prolonged periods of sitting with the legs in a dependent position, particularly after extended airline flights or car travel. Note that many travelers may have a mild degree of ankle swelling after prolonged travel that is not associated with DVT. This will usually resolve after walking or lying down after a few hours and is of no serious concern. However, leg swelling after travel that persists in spite of activity or lying for several hours should be evaluated.

To avoid DVT during travel, consider the following tips:

    On a long flight: get out of your seat periodically and walk up and down the aisle.
    On prolonged car trips, make frequent stops to stretch your legs.
    If you are unable to walk during travel, do isometric stretching exercises for your legs in your seat.
    If you have support hose, wear them on long flights
    On long trips, avoid wearing clothes that cause any constriction around the legs, thighs, or waist.

Source: Terence Ong, 2007. www.wikimedia.org

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Another possible cause of leg swelling that is sometimes difficult to distinguish from DVT is cellulitis. Cellulitis is a skin infection that often involves one leg. This may occur spontaneously or as a result of an open sore, penetrating injury, or blunt trauma to the leg. Note the bandaged toe in the photograph to the right. An infected toenail (or even athletes' foot) may be the source of a bacterial infection that ascends up the leg. Although there may be many causes of cellulitis, most cases are due to bacteria, either streptococci or staphylococci.

Cellulitis is painful and tender. Redness is invariably present and tends to move gradually up the leg. Swelling may be subtle or significant. Some patients may experience chills or fever.

Like DVT, cellulitis is a condition that requires prompt diagnosis and treatment. The treatment consists of an antibiotic, either oral or intravenous, depending on the severity of the infection. Complete resolution is the rule.

Source: Colm Anderson, 2006. www.wikimedia.org

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