Varicose veins differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]
Overview
Differentiating varicose veins from other diseases
Varicose veins maybe differentiated from other diseases that cause swelling in the lower limb. The differentials include the following:[1][2][3][4][5][6][7][8][9][10][11][12][13]
| Diseases | History and Symptoms | Physical Examination | Imaging | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Swelling | Pain | Nausea | Vomiting | Age/Gender | Location of swelling | Tenderness | Pulsatile mass | Ultrasonography | |
| Saphenous vein varicosity | + | +/- | - | - |
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Sephanofemoral junction (inferolateral to the pubic tubercle) | - | - | Duplex ultrasound determines the pattern of venous incompetence and reflux. |
| Femoral hernia | + | +/- | +/- | +/- |
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Below the inguinal ligament | +/-† | - | Slightly echogenic, long strip shaped omentum in the hernia sac. In cases of incarceration, expansion of a fluid filled bowel, intestinal fluid reflux and thickening and edema of intestinal wall. |
| Inguinal hernia | + | + | +/- | +/- |
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Above the inguinal ligament | +/-† | - | Abnormal ballooning of the anteroposterior diameter of the inguinal canal |
| Femoral artery aneurysm | + | - | - | - |
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Usually below the inguinal ligament | - | + | Duplex ultrasound used to differentiate between femoral artery aneurysm and femoral hernia |
| Lymphadenopathy | + | +/- | - | - |
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Femoral canal (medial to femoral vessels) | - | - | Internal echo in cases of lymphadenopathy |
| Lipoma | + | +/- | - | - |
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Occurs any where throughout the body | +/- | - | Echogenic solid mass, often misinterpreted as a fat containing hernia. |
†In cases of incarceration or strangulation, tenderness can be present.
References
- ↑ Diwan, Aparna; Sarkar, Rajabrata; Stanley, James C.; Zelenock, Gerald B.; Wakefield, Thomas W. (2000). "Incidence of femoral and popliteal artery aneurysms in patients with abdominal aortic aneurysms". Journal of Vascular Surgery. 31 (5): 863–869. doi:10.1067/mva.2000.105955. ISSN 0741-5214.
- ↑ Rigdon EE, Monajjem N (1992). "Aneurysms of the superficial femoral artery: a report of two cases and review of the literature". J. Vasc. Surg. 16 (5): 790–3. PMID 1433668.
- ↑ Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
- ↑ Berger D (2016). "Evidence-Based Hernia Treatment in Adults". Dtsch Arztebl Int. 113 (9): 150–7, quiz 158. doi:10.3238/arztebl.2016.0150. PMC 4802357. PMID 26987468.
- ↑ Yeh, Hsu-Chong; Lehr-Janus, Cynthia; Cohen, Burton A.; Rabinowitz, Jack G. (1984). "Ultrasonography and CT of abdominal and inguinal hernias". Journal of Clinical Ultrasound. 12 (8): 479–486. doi:10.1002/jcu.1870120805. ISSN 0091-2751.
- ↑ Yang XF, Liu JL (2014). "Acute incarcerated external abdominal hernia". Ann Transl Med. 2 (11): 110. doi:10.3978/j.issn.2305-5839.2014.11.05. PMC 4245506. PMID 25489584.
- ↑ Corder AP (1992). "The diagnosis of femoral hernia". Postgrad Med J. 68 (795): 26–8. PMC 2399298. PMID 1561184.
- ↑ King, Maurice (1987). Primary surgery. Oxford New York: Oxford University Press. ISBN 0192616943.
- ↑ Fitzgibbons RJ, Forse RA (2015). "Clinical practice. Groin hernias in adults". N Engl J Med. 372 (8): 756–63. doi:10.1056/NEJMcp1404068. PMID 25693015.
- ↑ Walker HK, Hall WD, Hurst JW, Amerson JR. PMID 21250263. Missing or empty
|title=(help) - ↑ Khilnani NM, Min RJ (2005). "Imaging of venous insufficiency". Semin Intervent Radiol. 22 (3): 178–84. doi:10.1055/s-2005-921950. PMC 3036278. PMID 21326691.
- ↑ Fornage BD, Tassin GB (1991). "Sonographic appearances of superficial soft tissue lipomas". J Clin Ultrasound. 19 (4): 215–20. PMID 1646225.
- ↑ Mirjalili SA, Muirhead JC, Stringer MD (2014). "Redefining the surface anatomy of the saphenofemoral junction in vivo". Clin Anat. 27 (6): 915–9. doi:10.1002/ca.22386. PMID 24648376.