Left Leg Swelling

[johnniehardrock]

I was wondering what the cause of water retention in my lower left leg and my foot would be from. I had a stress test and a cardiac cath on my heart less than two years ago and my heart was deemed "perfect" by my doctor so it would not appear to be a circulatory problem. I am “a little” overweight and I know that edema happens what can I do to help the problem.

[Dr Steve]

I was wondering what the cause of water retention in my lower left leg and my foot would be from. I had a stress test and a cardiac cath on my heart less than two years ago and my heart was deemed "perfect" by my doctor so it would not appear to be a circulatory problem. I am “a little” overweight and I know that edema happens what can I do to help the problem.


Johnnie:

There are a few things that can cause edema in only one leg (as opposed to both legs). things like congestive heart failure are "global" problems that would generally affect both legs.

Here are a few ideas:

1) Blood clot

When doctors see one leg swollen and the other normal, the first thing they'll often think about is a clot in one of the veins to the leg. Arterial blood can pump INTO the leg, but venous blood can't get out, so the leg puffs up. A simple doppler test can diagnose this. This is a serious complication, however, and needs to be looked at sooner rather than later, ok?

Sometimes the valves in the veins of one leg will fail, usually due to trauma or a previous blood clot...this will cause fluid retention as the vein cannot push blood out of the leg efficiently without a nice valve system.


2) Lymphedema

The interruption of the lymphatic channels by inflammation or blockage can also cause one leg to swell. This is usually pretty severe, though, and you'd already be at the doctor if you had this, I'd think. The most extreme version of this would be "elephantiasis", which can be caused by a parasite that blocks the outflow from the leg:

http://instruct1.cit.cornell.edu/courses/biog105/pages/demos/105/unit7/media/elephantiasis.jpg

Needless to say, I don't think you have that, but the photo is quite impressive.


3) A syndrome called "Left Lower Leg Edema (of the elderly)"

This is an interesting and totally benign form of edema, that is caused by an interesting anatomical fact. The right common iliac artery (the big artery going to the leg from the aorta) crosses over the left common iliac vein (the big vein draining the leg). In certain people, this will cause compression of the vein, restricting the outflow of blood from the leg, causing edema of the left leg only. If you don't believe me, here's an article from the medical literature:

J Am Board Fam Pract. 1993 Jan-Feb;6(1):1-4.
Left-sided leg edema of the elderly: a common variant of the iliac compression
syndrome.

Sloane PD, Baldwin R, Montgomery R, Hargett F, Hartzema A.

Department of Family Medicine, School of Medicine, University of North Carolina,
Chapel Hill 27599-7595.

BACKGROUND: Anatomically, the right common iliac artery crosses the left iliac
vein and its accompanying lymphatics. We hypothesized that this situation could
lead to a predominance of edema, telangiectasis, and venous varicosities on the
left lower extremities of older persons. METHODS: To test this hypothesis, a
research assistant who was blinded to the study goals examined 215 predominantly
elderly residents of North Carolina homes for the aged and disabled. RESULTS:
Among these subjects, 17.7 percent had predominantly left-sided edema, and 5.7
percent had predominantly right-sided edema (P < 0.001). When the 88 subjects
with pitting edema greater than 3 mm were studied, 34.5 percent showed a
left-sided predominance, and 6.9 percent showed a right-sided predominance (P <
0.001). In contrast, no significant difference was found in the lateralization of
venous varicosities or of telangiectasis. CONCLUSIONS: Asymmetric edema is common
and is usually left-sided in older persons. Compression of the left common iliac
vein and its accompanying lymphatics by the right iliac artery, rather than overt
clinical disease, might explain the majority of asymmetric edema seen in clinical
practice.


This last thing doesn't HAVE to happen in the "elderly", it's just more common in them. I'd get this checked out as soon as you can, and write back letting us know what it turned out to be. Hopefully it's just #3 and you'll have an interesting story to tell everyone (and you now know more anatomy than some MDs do, at least in regard to which artery lies over which vein!)

your pal,



steve