Varicose veins differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]

Overview

Varicose veins maybe differentiated from other diseases that cause swelling in the lower limb, such as femoral hernia, inguinal hernia, femoral artery aneurysm, lymphadenopathy and lipoma.

Differentiating varicose veins from other diseases

Varicose veins maybe differentiated from other diseases that cause swelling in the lower limb. The differentials include the following:

Diseases	History and Symptoms					Physical Examination			Imaging
	Swelling	Pain	Nausea	Vomiting	Age/Gender	Location of swelling	Tenderness	Pulsatile mass	Ultrasonography
Saphenous vein varicosity	+	+/-	-	-	Female	Sephanofemoral junction (inferolateral to the pubic tubercle)	-	-	Duplex ultrasound determines the pattern of venous incompetence and reflux.
Femoral hernia	+	+/-	+/-	+/-	Female > 45yrs	Below the inguinal ligament	+/-†	-	Slightly echogenic, long strip shaped omentum in the hernia sac. In cases of incarceration, expansion of a fluid filled bowel, intestinal fluid reflux and thickening and edema of intestinal wall.
Inguinal hernia	+	+	+/-	+/-	Male > 40yrs	Above the inguinal ligament	+/-†	-	Abnormal ballooning of the anteroposterior diameter of the inguinal canal
Femoral artery aneurysm	+	-	-	-	Male > 60 yrs	Usually below the inguinal ligament	-	+	Duplex ultrasound used to differentiate between femoral artery aneurysm and femoral hernia
Lymphadenopathy	+	+/-	-	-	Male and female	Femoral canal (medial to femoral vessels)	-	-	Internal echo in cases of lymphadenopathy
Lipoma	+	+/-	-	-	Male and female 40-60 yrs	Occurs any where throughout the body	+/-	-	Echogenic solid mass, often misinterpreted as a fat containing hernia.

†In cases of incarceration or strangulation, tenderness can be present.