title: Differentiation of functional venous insufficiency and leg lymphedema complicated by functional venous insufficiency using subcutaneous tissue ultrasonography.
abstract: To use subcutaneous ultrasonography to differentiate legs with edema because of obesity-related functional venous insufficiency (FVIob), immobility-related FVI (FVIim), secondary lymphedema (LE), LE complicated by obesity (LEob), and LE complicated by immobility (LEim).
  
  
  
  Ninety-nine legs with edema (16 FVIob, 32 FVIim, 22 LE, 9 LEob, and 20 LEim), and 10 normal legs were examined. Subcutaneous tissue ultrasonography was performed at eight points (medial, lateral, upper, lower, thigh, and calf) in each leg. Subcutaneous echogenicity (SEG) and subcutaneous echo-free space (SEFS) were assessed, and each graded as 0, 1, and 2 according to their severity.
  
  
  
  In normal legs, SEG and SEFS were graded 0 in almost all parts of the leg. SEG was diffusely increased in FVIob, whereas SEG was increased in accordance with gravity in FVIim(upper medial thigh, 0.6 ± 0.5 vs lower medial calf, 1.2 ± 0.4; P < .001). In LE, SEG was increased in the medial side, particularly evident in upper thigh (upper medial thigh, 1.1 ± 0.4 vs upper lateral thigh, 0.6 ± 0.6; P < .01). SEFS was increased in accordance with gravity in all of these legs (FVIob: upper medial thigh, 0.2 ± 0.4 vs lower medial calf, 0.7 ± 0.8; P = .05; FVIim: upper medial thigh, 0.1 ± 0.2 vs lower medial calf, 1.3 ± 0.7; P < .0001; LE: upper medial thigh, 0.4 ± 0.7 vs lower medial calf, 0.9 ± 0.9; P < .05). The increases of SEG and SEFS in legs with LEobor LEimwere diffuse and similar. As determined via stepwise logistic regression analyses, the increases in SEG in the upper medial thigh and SEFS in the lower medial thigh in LE cases, the increases in SEG in the upper lateral thigh and SEFS in the lower lateral thigh in cases with obesity-related leg edema (ie, FVIoband LEob), and the increase in SEFS in the lower lateral calf in cases with immobility-related leg edema (ie, FVIimand LEim) were determined to be significant factors to characterize each leg edema.
  
  
  
  Differences in the extent and distribution of SEG and SEFS might help in differentiating LE from FVIoband FVIim, although assessment of LE complicated by obesity vs immobility remains difficult.
authors.affiliation: Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan. Electronic address: ksuehiro-circ@umin.ac.jp.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Suehiro
authors.affiliation: Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Noriyasu
authors.initials: N
authors.lastname: Morikage
authors.affiliation: Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Yamashita
authors.affiliation: Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Samura
authors.affiliation: Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Takeuchi
authors.affiliation: Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Kimikazu
authors.initials: K
authors.lastname: Hamano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D004487:Edema / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D007866:Leg / Q000000981:diagnostic imaging*; D008209:Lymphedema / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012189:Retrospective Studies; D040521:Subcutaneous Tissue / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014689:Venous Insufficiency / Q000150:complications / Q000000981:diagnostic imaging*