Sonographic findings in patients with lower limb swelling, seen at Moi teaching and referral hospital, Eldoret- Kenya

Abstract

Background: Lower limb swelling is a nonspecific clinical presentation of various pathologies that have significant impact in clinical outcomes. Due to this non-specific nature, identifying the specific diagnosis is crucial for proper management. Imaging modalities play a major role in this and Ultrasonography has been shown to have comparable outcome with other techniques like Venography, in venous disorder diagnosis and MRI in soft tissue imaging. Objective: To describe the Sonographic findings of lower limb swelling among patients presenting at Radiology and Imaging department of MTRH. Research design and Methodology: This was a cross sectional study done at the Moi Teaching and Referral Hospital, Radiology and Imaging Department. The study population was patients with lower limb swelling, presenting to the department for imaging. A sample size of 103 was reached using Fisher’s formula. Consent was administered; the participant’s history, physical examination and sonographic findings were recorded. Data was analyzed using STATA version 10. Descriptive statistics (mean, median and range) were used for continuous variables while frequency listings were used for categorical variables. Correlation was done for clinical findings and Sonographic findings and Chi square test was used to assess associations between these categorical variables. Results: There were 103 participants. Their median age was 41 years and the majority were women 67 (65%). The main complaints were unilateral lower limb swelling 80 (77.7%), and pain in 54 (52.4%). Trauma and immobility were in 18 (17.5%) and 19 (18.4%) respectively. The main clinical examination findings were localized swelling in 63 (61.2%), the commonest location being in the lower leg 52 (50.5%). Redness was in 31 (30.1%) while tenderness was demonstrated in 41 (39.8%) cases. The most frequent Sonographic findings were deep venous thrombosis (DVT) 39 (37.9%). Lymphadenopathy and oedema were 9 (8.7%) each while varicose veins and cellulitis were 7 (6.8%) and 6 (5.8%) respectively. Arterial atherosclerosis and aneurysm, Baker’s cyst, pyomyositis and soft tissue tumour were less frequent findings. There was no association between onographic finding and gender, age or occupation. However, there was association between DVT and immobility (p<0.001), diffuse unilateral swelling (p=0.002) and tenderness (p<0.001). Conclusion and Recommendations: DVT was the commonest sonographic pattern (37.9%). There was association between DVT and history of immobility (p<0.001).