History

Bilateral leg swelling is usually due to systemic conditions, e.g. cardiac failure, while unilateral leg swelling is more often due to local causes, e.g. DVT, cellulitis. Pain will be associated with trauma, DVT, infection or complications of varicose veins. Other causes of swelling of the lower limb may be painless, although the limb may be uncomfortable if the oedema becomes tense. Evidence of the following should be sought in the past medical history: trauma to the limb, recent pregnancy (DVT), abdominal or pelvic malignancy, previous surgery or radiotherapy to lymph nodes, thyroid disease, congestive cardiac failure, renal failure, liver failure, malnutrition, poliomyelitis in childhood, nerve lesions. With primary lymphoedema, the leg may have been swollen since birth or oedema may have developed at puberty (lymphoedema praecox) or in the third decade (lymphoedema tarda).