Leg swelling due to urinary obstruction

Abstract

An 85-year-old man presented with bilateral leg edema and urinary incontinence. Abdominal examination revealed a severely distended bladder. Venous duplex of the legs demonstrated monophasic waveforms bilaterally, suggesting obstruction of proximal lower extremity veins. Relief of urinary obstruction was associated with the prompt return of normal respiratory variation of flow in the veins and improvement of leg swelling. Non-thrombotic obstruction of the proximal veins of the lower extremities by a severely enlarged urinary bladder is an infrequent yet potentially reversible cause of lower extremity edema. Subtle clues in the Doppler waveforms of an otherwise normal lower extremity venous duplex examination are crucial in establishing this diagnosis.

Keywords

Doppler waveforms lower extremity swelling urinary obstruction vascular ultrasound venous obstruction

References

Reix T , Sevestre H , Sevestri-Pietri MA , Szychta P , Pietri J . Primary malignant tumors of the venous system in the lower extremities. Ann Vasc Surg 1998; 12: 589–596.

Kinsella SM , Lee A , Spencer JA . Maternal and fetal effects of the supine and pelvic tilt positions in late pregnancy. Eur J Obstet Gynecol Reprod Biol 1990; 36: 11–17.

Carlsson E , Garsten P . Compression of the common iliac vessels by dilatation of the bladder. Report of a case. Acta Radiol 1960; 53: 449–453.

Evans JM , Owens TP Jr , Zerbe DM , Rohren CH . Venous obstruction due to a distended urinary bladder. Mayo Clin Proc 1995; 70: 1077–1079.

Bouachour G , Tirot P , Varache N , Dauphin M , Alquier P . Urinary bladder distention presenting as venous obstruction and hypovolemic shock. Am J Emerg Med 1991; 9: 563–564.

Kopesky K , Schwartz R , Silver D . Lower extremity edema from bladder compression of the iliac veins. J Vasc Surg 1988; 7: 778–780.