Edema of the left lower e...

A 17-year-old girl reports unilateral edema of the left lower extremity that has been present for two years. The patient claims to have had a badly healed ankle sprain in the affected extremity three years ago, which gradually cured but left with persistent swelling. The swelling fluctuates, reaching as high as the midcalf, yet there is a consistent baseline enlargement when compared to the opposing foot. Non pitting edema to the level of the malleoli is present on the left foot (Figure 1), which is nontender and free of discoloration. A positive Kaposi-Stemmer sign is the inability to pinch the skin at the base of the second toe (Figure 2). At the time of presentation, the thyroid function tests, total blood cell count, and chemical panel were all normal. Ultrasounds of the abdomen and pelvis revealed no signs of an obstructing mass or other abnormalities. Except for an occasional detection of tarsal coalition, primarily fibrous, between the calcaneus and talus, magnetic resonance imaging without contrast is negative.