Edema of the limb with myxedema, hemangioma. Differentiation of elephantiasis from obesity
As our experience shows, with the diagnosis of "elephantiasis of the lower extremities "The clinic is often sent to patients, as a rulewomen, with some form or degree of obesity. Nevertheless, although in obesity, the thickening of the limb is also found predominantly in women, in some of them, fat deposition occurs mainly on the lower limbs and the external signs are similar. However, with obesity, a symmetrical thickening of the lower extremities is noted, while with elephantiasis the lesion is, as a rule, one-sided and is not associated with obesity.
In rare cases, bilateral elephantiasis there is always an asymmetry of the thickened limbs. And further - after giving the elevated position of reducing the edema on the legs with obesity does not occur, the lower extremities have a cylindrical shape, the skin of the foot and fingers is slightly altered, elastic, freely taken into the fold, not thickened, the skin hangs over the foot in the form of thick folds that are not are soldered to the underlying tissues and can easily be raised, on the skin, in some patients, stretch marks are sometimes seen in the places where the fat deposits are greatest. Finally, with the change in body weight, the thickness of the legs also changes, which is not observed with true elephantiasis.
Two-sided thickening of the limbs may be associated with a thyroid diseasegland - pretybial myxedema. Unfortunately, many surgeons are not familiar with this pathology. With myxedema, both lower extremities swell. The main complaints of patients who find it difficult to choose the sizes of shoes are the disfigured look of the feet.
Swelling is tight, elastic. a skin of a dark pink color with separate foci of compaction, often merging with each other.
Sometimes there is excess growth coarse hair. The pits of the hair follicle give the appearance of pig skin.
Thickening of the legs after thyroidectomy is two-sided. There is soreness of the skin on palpation, it has a dark pink color. Obesity, exophthalmos complement the clinical picture.
It should be remembered about the so-called angiomatous elephantiasis. which is limited to the lesion of one upperor lower limb, but can also be localized simultaneously in other areas. The anatomical basis of this form of the disease is hemangioma, which is not always clinically possible to detect.
Set correct diagnosis help arterio- and flebography, as well as histological examination of tissues taken from the affected area.
Cavernous and branched hemangiomas. the diagnosis of which is less complex, often sprouting into soft tissues, muscles, bones. The extremity increases in thickness, sometimes very significantly, which can cause diagnostic errors.
Vascular tumors with test consistency. from pressure by a finger noticeably decrease,flatten, the skin pale at the same time, after the cessation of the pressure the tumor is again gradually filled with blood and the limb takes the previous form. The elasticity of the skin does not usually change. When the limb is lifted, the vascular cavities are released from the blood, the limb volume decreases markedly. Sometimes there is pulsation in branched angiomas, especially when they are in direct communication with large arterial vessels; a noise is heard. Often, in persons with common hemangiomas, the limb is longer (partial gigantism).
The presence of hemangiomatous spots, regardless of their size, should lead to the idea of hemangioma.