Etiology and diagnosis of bilateral leg XXXX in primary care.

@entity1 @entity2313 @entity712 @entity4988 @entity4 @entity120 @entity4096 @entity299
PURPOSE: To identify the causes of bilateral leg @entity4 in a primary care setting, and to determine the ability of primary care providers to arrive at the correct diagnosis using the information available at the initial clinical encounter. @entity1 AND METHODS: Fifty-eight ambulatory adult @entity1 with bilateral leg @entity4 were enrolled at an inner city family practice during a 3-year period. Historical information, physical examination findings, and clinical impressions of primary care providers were compared with the results of laboratory evaluations consisting of echocardiograms, venous duplex ultrasound leg scans, serum @entity2313 levels, and when appropriate, 24-hour urinalyses. RESULTS: Forty-five @entity1 (78%) completed the study. The initial clinical impression was @entity4096 in 32 (71%) @entity1 and @entity712 in 8 (18%) @entity1 . In actuality, 15 (33%) @entity1 had a @entity299 as a cause of their leg @entity4 , and 19 (42%) had @entity120 . All of the @entity1 with @entity299 , and almost all of those with @entity120 , were age 45 years or older. Only 10 (22%) of the subjects had @entity4096 . Renal conditions, medication use, and @entity4988 were less common. CONCLUSIONS: Utilizing clinical information only, many @entity1 with cardiopulmonary pathology were incorrectly diagnosed as having more benign conditions, most commonly @entity4096 . Echocardiographic evaluation, including an estimation of pulmonary artery pressure, may be advisable in many @entity1 with bilateral leg @entity4 , especially if they are at least 45 years old.
