1. Unilateral leg swelling is a common clinical presentation, with deep vein thrombosis (DVT) often the top differential. However, not infrequently, a range of pathologies are instead diagnosed. 2. Overview of the anatomy of the lower limb 3. To provide a pictorial review of the common causes of painful swollen lower leg. 4. To highlight the need to consider alternative diagnoses, when a venous thrombosis is excluded, as a cause of the painful swollen leg.

Unilateral painful swollen leg is a commonly encountered presentation. Over a century ago,Virchow described the classic triad of predisposing factors for DVT, namely, venous stasis, injury of the vascular wall, and a hypercoagulable state [1].Events or conditions that alter the equilibrium of one or more of these factors may produce DVT. Deep venous thrombosis (DVT) is often the top differential that needs to be excluded as it can have serious consequences, both fatal and non-fatal. However, only a quarter of patients evaluated for DVT of...

Normal lower leg anatomy: The swollen painful leg: Deep vein thrombosis (DVT): DVT is one of the most prevalent medical problems today. Lower-extremity DVT is the most common venous thrombosis, with a prevalence of 1 case per 1000 population and the underlying source of 90% of acute pulmonary emboli [4]. Imaging features: Ultrasonography is the current first-line imaging examination. Acute thrombosis (~ 14 days) Low echogenicity thrombus: May be virtually anechoic, flow may be seen within recanalised thrombus. Venous distension: Recently thrombosed veins are distended...

DVT of the lower limb is preventablecauseof mortality and morbidity. Its presentation is non-specific and often presenting as a painful swollen leg. Not infrequently, a range of other pathologiesare diagnosed instead. The use of risk stratification, d-dimers and clinical history should help guide management, however it is important to bevigilant before diagnosing a DVT in low risk patientspresenting with a painful swollen calf asd-dimer levels alone could be misleading as levels could be moderately elevated in other pathologies. A delay in diagnosing tumours could affect...

A Shah, Department of Radiology, University Hospitals of Leicster, Infirmary Square, Leicester, LE1 5WW, UK. R Botchu, Department of Radiology, Royal Orthopaedic Hospital, Birmingham,B31 2AP, UK. W Adair,Department of Radiology, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK. WJ Rennie, Musculoskeletal Radiologist, Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK.

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