Amaç: Alt ekstremite ödemi yoğun poliklinik koşullarında fiziyatristler için tanısal zorluk oluşturmaktadır. Ayırıcı tanı primer olarak medikal öykü, fizik muayene ve ödem klinik özelliklerine dayanır. Klinisyenlere lenfödem polikliniğine bacak şişliği nedeniyle başvuran hastaların demografik ve klinik özelliklerini sunmayı ve bacak ödemi ayırıcı tanısı için bir rehber oluşturmayı amaçladık. Gereç ve Yöntemler: Fiziksel tıp ve rehabilitasyon lenfödem polikliniğine 2014 ve 2016 yılları arasında bacak şişliği nedeniyle başvuran 95 hasta retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, medikal öyküleri, fizik muayeneleri, laboratuar testleri ve gerekliyse görüntüleme tetkikleri incelendi. Bulgular: Hastalarin %47,3'une lenfodem, %40'ina kronik venoz yetmezlik, %5,3'une lipodem, %3,2'sine kalsiyum kanal blokoru kullanimina bagli odem, %3,2'sine idiopatik odem ve %1'ine lipo-lenfodem tanisi kondu. Sonuç: Alt ekstremitre ödemi tanısal zorluk oluşturmaktadır. Ayırıcı tanı oldukça geniş bir yelpazede medikal hastalık içermektedir. Bu makale bacak ödemi ayırıcı tanısı için bir rehber oluşturacaktır.

Objective: Differential diagnosis of lower extremity edema is a diagnostic challenge for clinicians in busy outpatient clinics. A wide range of diseases must be considered in the differential diagnosis. Differential diagnosis is primarily based on the medical history, physical examination, and clinical presentation of edema. We aimed to present the demographic and clinical characteristics of the patients referred to the lymphedema outpatient clinic with swollen legs and to provide a diagnostic guide in the differential diagnosis of leg edema for clinicians. Material and Methods: Ninety-five patients referred to a physical and rehabilitation medicine lymphedema outpatient clinic with leg swelling between 2014 and 2016 were evaluated retrospectively. Demographic characteristics, medical history, physical examination, laboratory tests, lower extremity venous Doppler US, and if necessary, the other imaging tests were assessed. Results: Forty-seven percent three percent of patients were diagnosed as having lymphedema, 40% as having chronic venous insufficiency, 5.3% as having lipedema, 3.2% as having edema associated with calcium channel blockers usage, 3.2% as having idiopathic edema and 1% as having lipo-lymphedema. Conclusion: Lower extremity edema is a diagnostic challenge. A wide range of diseases must be considered in the differential diagnosis. This article provides a guide to the differential diagnosis of leg edema for clinicians.

1. Atkin S. Bilateral pitting oedema with multipl aetiologies. Aust J Herb Med 2013;25:79-82. [Link] 
2. Ely JW, Osheroff JA, Chambliss ML, et al. Approach to leg edema of unclear etiology. J Am Board Fam Med. 2006;19:148-60. Erratum in: J Am Board Fam Med. 2008;21:86. [Crossref]  [PubMed] 
3. Tiwari A, Cheng KS, Button M, et al. Differential diagnosis, investigation, and current treatment of lower limb lymphedema. Arch Surg. 2003;138:152-61. [Crossref]  [PubMed] 
4. International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology. Lymphology. 2003;36:84-91. [PubMed] 
5. Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg. 1995;21:635-45. [Crossref]  [PubMed] 
6. Bozkurt K, Rabe E, Sharkawy MI. Chronic venous insufficiency: management and treatment. EMJ Dermatol. 2017;5:2-13. [Crossref]  [Link] 
7. Kostanoğlu A, Başbuğ Mbata G, Yılmaz Gökmen G, et al. The Lymphedema Functioning, Disability, and Health Questionnaire for Lower Limb Lymphedema: Translation, reliability, and validation study of the Turkish version. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2017;25:586-9. [Crossref] 
8. Öz Savaş B, Sargın M, İyem H, et al. Alt ekstremitede lenfödem sıklığı ve etkili faktörler [The incidence and factors influencing lymphedema in lower extremities]. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2006;14:304-7. [Link] 
9. Priollet P. Venous edema of the lower limbs. Phelebolymphology. 2006;13:183-94. [Link] 
10. Hlibczuk V, Waseem M, Nguyen A, et al. The swollen extremity: a systematic approach to the evaluation of a common complaint. Emergency Medicine Practice (EBMedicine.net). 2006;8:1-28. [Link] 
11. Warren AG, Brorson H, Borud LJ, et al. Lymphedema: a comprehensive review. Ann Plast Surg. 2007;59:464-72. [Crossref]  [PubMed] 
12. Raju S, Furrh JB 4th, Neglén P. Diagnosis and treatment of venous lymphedema. J Vasc Surg. 2012;55:141-9. [Crossref]  [PubMed] 
13. Shin BW, Sim YJ, Jeong HJ, et al. Lipedema, a rare disease. Ann Rehabil Med. 2011;35:922-7. [Crossref]  [PubMed]  [PMC] 
14. Kesieme E, Kesieme C, Jebbin N, et al. Deep vein thrombosis: a clinical review. J Blood Med. 2011;2:59-69. [Crossref]  [PubMed]  [PMC]