Swelling of Both Ankles

CLINICAL DIAGNOSTIC MANUAL

Swelling of both ankles, also known as bilateral oedema, is a common condition that can result from various underlying causes, including cardiovascular, renal, hepatic, and lymphatic issues.

This condition may be a sign of fluid retention in the body, indicating dysfunction in the circulatory or lymphatic systems. Identifying the underlying cause is essential for appropriate management and to prevent potentially serious complications.

Pathology	Suspected Diagnosis	Confirmatory Diagnosis
Right ventricular failure	Bilateral ankle swelling, dyspnoea, ascites, hepatomegaly.	Echocardiogram, chest X-ray, blood tests.
Venous insufficiency	Bilateral swelling, leg heaviness, visible varicose veins.	Venous Doppler ultrasound, physical examination.
Hypoalbuminaemia states	Generalised swelling, fatigue, pale skin, low blood albumin.	Blood tests, urine analysis.
Bilateral cellulitis	Swelling, redness, warmth, and pain in both ankles.	Physical examination, skin cultures.
Inferior vena cava obstruction	Swelling of the lower limbs, abdominal varices.	Abdominal CT or MRI, venous Doppler ultrasound.
Medications	Bilateral swelling temporally related to starting a new medication.	Medication review, clinical history.
Bilateral venous thrombosis	Painful swelling, tense skin, skin colour changes.	Venous Doppler ultrasound, blood tests for D-dimer.
Lymphatic drainage insufficiency (lymphoedema)	Chronic swelling, thickened skin, changes in skin texture.	Lymphangiography, ultrasound, physical examination.