Diagnostic Dilemma

Bilateral congenital pedal edema


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Question
A 2 months old boy born of non-consanguineous marriage presented with swelling over both feet since birth. There was no increase or decrease in size of swelling. There was no breathlessness, edema elsewhere or pallor. On examination, the child had non-pitting edema of both lower limbs. Other systems were normal.

What is the diagnosis and how should this child be managed?
Expert Opinion :
Since this child has non-pitting edema it suggests either a lymphedema or myxedema. Edema due to vascular cause would have pitting edema and there would be increase in edema as day progresses. Hypoalbuminemia would also not cause swelling only in the feet. Since the child has no other features of hypothyroidism, thus myxedema seems unlikely. The cause of edema feet in this child is thus congenital lymphedema. The diagnosis is usually made with a thorough history and physical examination. Lymphangiogram has been shown to cause an inflammatory reaction of the endothelium of the remaining lymphatic channels, leading to scarring, atrophy, and even luminal obliteration. Thus it is not recommended now. Lymphoscintigraphy, MRI or doppler may be used instead. Treatment consists of compression bandage. Surgery may be required only if there is limitation of movement.
Answer Discussion :
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