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October 9, 1981

Unilateral Leg Edema

JAMA. 1981;246(15):1660. doi:10.1001/jama.1981.03320150020015

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To the Editor.—  I would like to add a caveat to the recent article by Hawkins et al (1980;244:2640) on unilateral leg edema as a symptom of lymphoma. This is the kind of article that is seized on by modern house officers as an excuse for ordering an extensive workup (ie, gallium scan, bone scan, skeletal survey, venogram, and lymphangiogram) when it is not indicated.The most common cause of unilateral leg edema is any edema-forming state in the presence of underlying disease of the veins or lymphatic channels (ie, old fracture, old phlebitis, and old surgery). When the edema of any fluid overload state (congestive heart failure, cirrhosis, nephrotic syndrome, pregnancy, or long-standing diabetes mellitus with leaky vessels) is just beginning, it is not infrequently unilateral. Simple questioning about old disease in the extremity is usually all that is required to explain the unilaterality of the edema. While it