A New-Proposal Physical Examination Test for Unilateral Lower Extremity Edema

  • Fatih Ada Department of Cardiovascular Surgery, Cumhuriyet University School of Medicine, Sivas, Turkey
  • Volkan Emren Department of Cardiology, İzmir Katip Çelebi University School of Medicine, Izmir, Turkey


Objective: Patients with iliac vein compression syndrome (IVCS) usually present to the hospital with left-sided leg edema. We looked for an answer to the question: ‘’Can iliac vein compression syndrome (IVCS) be predicted with a reliable physical examination test in the differential diagnosis?’’

Methods: We tested a new physical examination on patients with only left-sided lower extremity edema. In this physical examination the widest area of the calf point (just below tuberosity of the tibia) and medial malleolus was measured in both legs on the Trendelenburg position at 30°and repeated in standing position. Then the iliac venography was performed.

Results: The test was performed on 32 (N = 32) patients with left extremity edema. IVCS was observed on 18 (n = 18) (56%) patients. The test was found to have 88% sensitivity and 92% specificity in IVCS.

Conclusion: This new physical examination finding, which may be valuable in diagnosing IVCS, is proposed for use in patients with unilateral left-sided edema to preclude unnecessary use of expensive diagnostic imaging methods.


Bickley LS, Szilagyi PG. Bates’ guide to physical examination and history-taking. 11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; c2013.

Boyd DA. 2004. Unilateral lower extremity edema in May-Thurner syndrome. Mil Med 169(12):968-71.

Eberhardt RT, Raffetto JD. 2005. Chronic venous insufficiency. Circulation 111(18):2398-409.

Guex JJ, Perrin M. 2000. Edema and leg volume: methods of assessment. Angiology 51(1): 9-12.

Hurst DR, Forauer AR, Blooem JR, Greenfield LJ, Wakefield TW, Williams DM. 2001. Diagnosis and endovascular treatment of iliocaval compression syndrome. J Vasc Surg 34(1):106-13.

May R, Thurner J. 1956. [A vascular spur in the vena iliaca communis sinistra as a cause of predominantly left-sided thrombosis of the pelvic veins]. Z Kreislaufforsch 45(23-24):912-22. German.

May R, Thurner J. 1957. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology 8(5):419-27.

Mohammed KA. 2016. Clinical examination nowadays. Lancet 388(10044):559-60.

Mousa AY, AbuRahma AF. 2013. May–Thurner syndrome: update and review. Ann Vasc Surg 27(7):984-95.