Peripheral edema

Peripheral edema
Massive peripheral edema (Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
ICD-10	R60.0
ICD-9	782.3

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Overview

Competent venous valves, intermittent leg muscle contraction and respiration is required to support normal venous blood return. When these fail, venous insufficiency and edema occur. Edema can occur in 2 forms: pitting and non-pitting. Pitting occurs when there is fluid movement when pressure is applied. Non-pitting is swelling of the tissue itself, not an excess of fluid surrounding the tissue.

Epidemiology and Demographics

25% of the general population suffers from chronic venous insufficiency.

Differential diagnosis of causes of peripheral edema

In alphabetical order:

• Cellulitis
• CHF
• Cirrhosis
• Constrictive pericarditis
• DVT
• Nephrotic Syndrome
• Venous insufficiency

Diagnosis

History and Symptoms

• History should include:

• DVT risk factors
• time lapse
• other associated symptoms
• unilateral vs. bilateral
• pitting and/or non-pitting

(Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)

• 

  Moderate edema

• 

  Massive edema

Laboratory Findings

• Labs include:

• Blood cultures
• BUN / creatinine
• CBC
• Coagulation
• Electrolytes
• LFTs
• Serum albumin
• Thyroid function tests
• Urinalysis

Chest X Ray

• Chest X-Ray may indicate pulmonary edema and/or cardiomegaly

Echocardiography or Ultrasound

• Duplex ultrasound for DVT
• Echocardiography for EF in patients with CHF

Other Diagnostic Studies

• liver biopsy for cirrhosis

Treatment

Acute Pharmacotherapies

• Congestive heart failure: ACE inhibitors, beta blockers, digoxin

Chronic Pharmacotherapies

• DVT: Anticoagulation with unfractionated heparin, low molecular weight heparin / warfarin for 3-6 months

Indications for Surgery

• Nephrotic syndrome: transplant in adult patients may be necessary
• Cirrhosis: liver transplant may be necessary

Additional therapies

• Venous insufficiency: Leg elevation, compression stockings, minimize time standing
• Cellulitis: extremity elevation
• CHF: Salt restrictions
• Cirrhosis: Diuretics & low salt diet

Prognosis

Successful treatment depends on control of the underlying cause. Severe swelling can cause permanent damage to nerves, resulting in peripheral neuropathy. Many cases from temporary or minor causes resolve on their own, with no lasting damage.

Additional Resources

• Cho S, Atwood J (2002). "Peripheral edema". Am J Med. 113 (7): 580–6. doi:10.1016/S0002-9343(02)01322-0. PMID 12459405.

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