When the patient lies down, these swellings vanish
What is the differential diagnosis

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Varicose veins are a very common, familial disorder, caused by failure of venous valves which prevent retrograde blood flow from the deep venous system into the superficial and then down the leg. The most common, initial valve to fail guards the junction of the long saphenous vein with the femoral vein, lying just 2-3 cms below and lateral to the pubic tubercle. This allows blood to pass from the femoral vein, back into the long saphenous vein which becomes stretched over time. If this stretching becomes extensive then a saphena varix appears as shown above. More commonly, the stretching extends down the long saphenous reaching the next valve. As the valve cusps separate then this valve also becomes incompetent allowing the blood to pass further down the leg. As more and more valves are damaged, the varicose veins appear to extend further down the leg and into the calf. Patients, with veins in the calf, are often unaware that the primary problem occurs high in the groin. Primary incompetence may also occur at the junction of the short saphenous vein with the popliteal vein, behind the knee. The classical examination technique is Trendelenburg testing which employs sequential tourniquets placed at intervals down the leg, releasing them one by one to determine the site of the valve incompetence between the deep and superficial venous systems. Duplex scanning techniques are now widely used to more accurately determine the site of incompetence and plan surgery, particularly in cases of recurrent varicose veins. Recurrence occurs in over 10% of operated cases due to a combination of poor initial surgery, recanalisation of veins and development of new incompetent valves over time.