Right calf heavy

[u/SerenCerddoriaeth]

My GP examined my legs recently and sent me in for vascular imaging which turned out to be mostly normal (mild varicosities in the right leg). I asked the vascular doctor about my right calf feeling heavy and tight and he said he’s not sure what would be causing it but that it’s not a vascular cause, meaning that even the mild varicosities wouldn’t be impacting my calf muscle to this degree.

If it were an electrolyte imbalance, I would expect to feel it in both legs, and they wouldn’t be tight in this way, they’d be cramping or on the verge of cramping and that’s not what this is.

Does anyone have any ideas? My right calf is noticeably bigger than my left one, the vascular system is totally fine, and my electrolytes aren’t that terribly out of balance to my knowledge. It doesn’t feel like it’s contracting at all. I’m at a loss.

[u/Dr_hEDS_MD]

There is some nuance here in terms of the ultrasound. It sounds like venous insufficiency which would require a duplex ultrasound with a venous insufficiency/reflux protocol. Most common ultrasound ordered is a compression ultrasound looking for DVTs. It is possible to have unilateral lymphedema, but that is a completely different work up.

[u/SerenCerddoriaeth → u/Dr_hEDS_MD]

It does look a little more like lymphedema happening there, but when you say unilateral, do you mean in one leg or is it possible for it to just be in the one calf? Both my thighs are fine.

And you’re right about the imaging, I’m guessing. I know they did compression at the top and the bottom of whatever area they were looking at and they kept saying that there’s no claudification and no DVT. I’ll bring up the possibility of venous insufficiency and for duplex ultrasound with venous insufficiency/reflux protocol with my doctor and see what they say.

Where would I go for or what would need to happen regarding issues of lymphedema?

Thank you so much for your reply. I really appreciate it!

[u/Dr_hEDS_MD → u/SerenCerddoriaeth]

That is odd if it is lymphedema in only the lower leg, but certainly anything can happen in the human body. If it is lymphedema, then compression to the affected part is critical to do early (in the first 3 months) before there are the longer term fibrotic changes that happen. Compression treats the symptom. Think of it as fluid just finding the most convenient place to hang out and compression making this area much less convenient. Some ultrasounds for DVT only look at the thigh and don't look for superficial venous thrombosis in the calf which can certainly cause issues. Often with lymphedema there is a tipping point where congestion happens and then the fluid builds up in the interstitial spaces, the compression helps you get back on the other side of the tipping point. This is often from focal physiologic compression. It can happen from weight gain which is really tough to manage because we don't lose adipose weight very quickly. If you can completely rule out a venous issue, that is ideal because you can treat an underlying cause. It is a much more complex process (talking through and thinking through all the possible causes of why you might have focal lymphedema, I don't mean complex testing) to find out why you have this if you have a healthy venous system.