Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research
  Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login  
  Home Print this page Email this page Small font sizeDefault font sizeIncrease font size Users Online: 1850       

   Table of Contents      
CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 76-77

An unusual cause of massive right leg swelling


Department of Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India

Date of Submission15-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Debarchan Barman Roy
Department of Medicine, All India Institute of Medical Sciences, New Delhi 110 029
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2100_19

Rights and Permissions

How to cite this article:
Roy DB, Ray A. An unusual cause of massive right leg swelling. Indian J Med Res 2020;152, Suppl S1:76-7

How to cite this URL:
Roy DB, Ray A. An unusual cause of massive right leg swelling. Indian J Med Res [serial online] 2020 [cited 2021 Jul 29];152, Suppl S1:76-7. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/76/316703

Patient's consent obtained to publish clinical information and images.


A 27 yr old male, non-smoker, presented to the department of Medicine, All India Institute of Medical Sciences, New Delhi, India in April 2019, with debilitating swelling of the right leg which started around two weeks ago. His physical examination showed pitting pedal odema of the right leg [Figure 1]. Routine blood tests, spirometry, tuberculin skin test, two-dimensional echocardiography and lower limb venous Doppler were unremarkable. Serum angiotensin-converting enzyme levels were elevated, while serum and urine calcium levels were normal. Chest imaging and subsequent whole-body positron emission tomography and computed tomography showed mediastinal lymphadenopathy [Figure 2]. Bronchoscopy with trans-bronchial needle aspiration (from the right paratracheal node) showed non-necrotising epithelioid cell granuloma [Figure 3]. Lymphoscintigraphy showed significant lymphatic obstruction of the right lower limb [Figure 4]. He was diagnosed as sarcoidosis with lymphatic involvement, leading to massive pedal odema. Treatment involved steroids to which he showed remarkable clinical improvement within four weeks. This was a rare presentation of a common disease, sarcoidosis.
Figure 1: Severe pitting pedal oedema of the right leg of the patient; making it difficult for him to walk or drive his car.

Click here to view
Figure 2: A mediastinal lung window of 18-fluorodeoxyglucose positron emission tomography and computed tomography showing prominent bilateral interlobar (blue arrows) and sub-carinal (red arrow) lymphadenopathy; the florid fluorodeoxyglucose uptake signifies an active disease process.

Click here to view
Figure 3: A haematoxylin and eosin-stained slide prepared from lymph node tissue derived from the right paratracheal lymph node; tissue was secured by endobronchial ultrasound sonography-guided trans-bronchial lymph nodal aspiration. It shows the presence of elongated nuclei within the macrophages (blue arrow) suggesting epithelioid granuloma with no evidence of necrosis; these features are suggestive of non-necrotizing granulomatous lymphadenitis; consistent with a picture of sarcoidosis (×400).

Click here to view
Figure 4: A 99m-Tc sulphur colloid lymphoscintigraphy of both lower limbs; anteriorly the dye has reached both the inguinal nodes freely; posteriorly the dye has reached the left deep inguinal lymph node (blue arrow) but has not completely reached the deep inguinal lymph node on the right; thus signifying a lymphatic obstruction at the right popliteal lymph node (red arrow).

Click here to view


Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Article Figures

 Article Access Statistics
    Viewed148    
    Printed0    
    Emailed0    
    PDF Downloaded27    
    Comments [Add]    

Recommend this journal