Swollen leg mystery

[avf]

Hi, Im a 25 y/o female, I dont smoke, I have had no injuries, I was on the patch until my problem began, no air travel either. So heres what happenned, About 9 wks ago, I noticed that my right leg was swollen below the knee, mostly the calf, not so much towards the ankle and foot, I experienced paresthesia and minor discomfort(pain), no discoloration or change in temperature form the other leg.  I went to the ER, got a d-dimmer test which was positive, and my leg was about 2in bigger that the other, got a heparin shot for 4 days but when I had the doppler done it was negative.   Dr. sent me home to put my leg up on pillows.  I had a ct scan of my abdomen which was normal.  meanwhile my leg very very slowly when back to almost normal size, and then 3 wks after the first incident it happenned again.  This time the pain was pretty bad, and the leg was bigger also, no discoloraton or change in temperature.  Went to the er again, same thing, ddimer positive, got heparin shots, ultrasound negative again.  The dr. ordered some xrays and blood test but everything is normal.  the dr told me she had no clue what it was  and that it was probably the heat or that my veins are "lazy", she referred me to an internist but lucky me the appoinment is in december.  This time the swelling and discomfort dont seem to go away the closest to normal size it has been is about 3/4 in bigger than the other, and when I walk for longer than 20 min it hurts and swells up some more.  so basically Ive been sitting at home with my leg propped up on pillows.  The leg has swollen up twice more went to the dr once they told me it was nothing so the next time i decided to just stay home.  Sorry for the long post but im really frustrated and i want to get some ideas as to what could be causing my symptoms.  Im a paramedic and know more than my share to know this is not normal and it cant just be nothing. Thank you in advance and Ill be waiting for someone to shed light on my problem, Thanks again AVF

[Bhupinder Kaur, MD]

Hello,

I’m glad that you have not cancelled your doctor’s appointment in December.Unilateral(on one side)leg swellingand pain without any prior injury is always pathological.The pathologu has to be diagnosed after examination and investigations.

Till the time of your next appointment,keep the leg elevated.You can also leg wedges to elevate the feet while sleeping.Support socks and stockings are also useful.Wear proper fitting shoes and avoid standing in place for long period of time or  sitting with the feet dependent. Limit salt intake and drink plenty of water.Avoid contraceptive pills and hormone replacement therapy if you are taking it.

This should help. Take care and pls let me know what your doctor says.God bless.

[avf]

Hi, first of all thanx for answering to my post.  Well, I was "lucky" enough to get an appointment with some random internist yesterday, but it didnt turn out like I thought it would.  At first, they Dr seemed nice enough, and seemed concerned and everything, assuring me he would get to the root of my problem, anyways when it came to the physical examination he said he didnt see a big difference in my legs size wise, if any at all, he proceeded to poke my legs and decided that I didnt have pitting edema and the "minimal increase" in sz of my R leg below the knee is muscle.  Then he went and talked it over with his collegues and the veredict was that since my leg is not red then I do not have dvt or anything I should be concerned with.  And I was sent home.  Needless to say I feel very frustrated, I mean its my leg and Ive known it for longer that anyone else to know if its swollen or not, plus how exactly did I manage to develop "the muscle" in my R calf that I didnt have 3 months ago?? also another way I can tell is because Ive measured it, obsessively, since the first incident, and my knee high boots wont close.  I would say thats evidence enough but I guess not to this Dr.  Thank God I didnt cancel the appointment I have in december, and that Dr. ordered an MRI so he can have the results of everything before he sees me.   Lets hope it works out this time.  Do you have any advice?? Apart from having my leg elevated, do you think wearing one of those neoprene calf supports would be beneficial?? I think Im done with my ranting for now at least =), thanx again

[Bhupinder Kaur, MD]

Hello,

The various possibilities for your symptom of unilateral swollen and painful calf are cellulitis(an infection of the deep subcutaneous tissue of the skin.Blodd cultures are needed for diagnosis),arterial occlusion(MRA is helpful),compartment syndrome(increased pressure (usually caused by inflammation) within a confined space (fascial compartment) in the body impairs blood supply),pseudophlebitis,limb-girdle muscular dystrophy and sarcoglycanopathy.

Pls discuss these options with your doctor.
Hope it helps.Take care and pls do keep me posted on how you are doing or if you have any additional queries