Edema resident survival guide: Difference between revisions

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{{SK}}
{{SK}} Generalized edema, localized edema, unilateral edema, bilateral edema
==Overview==
==Overview==
[[Edema]] is an abnormal collection of fluid in interstitial space because of an imbalance in [[hydrostatic pressure]], [[oncotic pressure]], increased [[capillary permeability]], and obstruction in [[lymphatic drainage]].
[[Edema]] is an abnormal collection of fluid in interstitial space because of increased [[hydrostatic pressure]], decreased [[oncotic pressure]], increased [[capillary permeability]], and obstruction in [[lymphatic drainage]]. [[Edema]] may be  due to underlying systemic diseases such as [[nephrotic syndrome]], [[ right sided heart failure]], [[hypothyroidism]], [[hyperthyroidism]], side effect of some drugs, complications of recent [[surgery]] and [[malignancy]]. [[Edema]] may be generalized due to [[cardiac]], [[thyroid]], [[kidney]] diseases or localized due to [[cellulitis]], [[deep vein thrombosis]] ([[DVT]]), [[chronic venous insufficiency]] and [[lymphedema]]. Diagnosis is based on taking history of recent [[surgery]], [[trauma]], [[systemic illness]], [[malignancy]] and  doing physical examination about the distribution of [[edema]] and determination of [[pitting]] or [[non pitting edema]], inducing  [[pain]] on palpation. [[Duplex sonography]] is helpful for finding the evidence of [[DVT]]. For more investigation about localized [[edema]] with unknown etiology, [[abdominal computer tomography]], [[magnetic resonance venography]] maybe required.


==Causes==
==Causes==
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Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
*[[Generalized edema]] caused by [[decompensated heart failure]]   
*[[Generalized edema]] caused by [[decompensated heart failure]]   
* Unilateral [[leg edema]] caused by proximal [[deep vein thrombosis]] leading to acute [[pulmonary embolism]]
* Localized [[leg edema]] caused by proximal [[deep vein thrombosis]] leading to acute [[pulmonary embolism]]


===Common Causes of peripheral edema===
===Common Causes of peripheral edema===
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==Diagnosis==
==Diagnosis==
Shown below is an algorithm summarizing the diagnosis of <nowiki>edema</nowiki>.<ref name="pmid25657974">{{cite journal |vauthors=Joob B, Wiwanitkit V |title=Acute bilateral leg edema due to levofloxacin |journal=J Family Med Prim Care |volume=3 |issue=4 |pages=475–6 |date=2014 |pmid=25657974 |pmc=4311373 |doi=10.4103/2249-4863.148158 |url=}}</ref><ref name="pmid23251178">{{cite journal |vauthors=Hosseini SH, Ahmadi A |title=Peripheral Edema Occurring during Treatment with Risperidone Combined with Citalopram |journal=Case Rep Med |volume=2012 |issue= |pages=540732 |date=2012 |pmid=23251178 |pmc=3510775 |doi=10.1155/2012/540732 |url=}}</ref><ref name="pmid15675326">{{cite journal |vauthors=Kaizu K, Abe M |title=[Drug-induced edema] |language=Japanese |journal=Nippon Rinsho |volume=63 |issue=1 |pages=102–6 |date=January 2005 |pmid=15675326 |doi= |url=}}</ref><ref name="pmid17433897">{{cite journal |vauthors=Cushman M |title=Epidemiology and risk factors for venous thrombosis |journal=Semin. Hematol. |volume=44 |issue=2 |pages=62–9 |date=April 2007 |pmid=17433897 |pmc=2020806 |doi=10.1053/j.seminhematol.2007.02.004 |url=}}</ref><ref name="pmid28878840">{{cite journal |vauthors=Spiridon M, Corduneanu D |title=Chronic Venous Insufficiency: a Frequently Underdiagnosed and Undertreated Pathology |journal=Maedica (Buchar) |volume=12 |issue=1 |pages=59–61 |date=January 2017 |pmid=28878840 |pmc=5574075 |doi= |url=}}</ref><ref name="pmid7603138">{{cite journal |vauthors=Dupas B, el Kouri D, Curtet C, Peltier P, de Faucal P, Planchon B, Lejeune JJ |title=Angiomagnetic resonance imaging of iliofemorocaval venous thrombosis |journal=Lancet |volume=346 |issue=8966 |pages=17–9 |date=July 1995 |pmid=7603138 |doi=10.1016/s0140-6736(95)92650-x |url=}}</ref><ref name="Kataoka2013">{{cite journal|last1=Kataoka|first1=Hajime|title=Clinical Characteristics of Lower-Extremity Edema in Stage A Cardiovascular Disease Status Defined by the ACC/AHA 2001 Chronic Heart Failure Guidelines|journal=Clinical Cardiology|volume=36|issue=9|year=2013|pages=555–559|issn=01609289|doi=10.1002/clc.22159}}</ref><ref name="pmid27923806">{{cite journal |vauthors=Yeboah J, Bertoni A, Qureshi W, Aggarwal S, Lima JA, Kawel-Boehm N, Bluemke DA, Shah SJ |title=Pedal Edema as an Indicator of Early Heart Failure in the Community: Prevalence and Associations With Cardiac Structure/Function and Natriuretic Peptides (MESA [Multiethnic Study of Atherosclerosis]) |journal=Circ Heart Fail |volume=9 |issue=12 |pages= |date=December 2016 |pmid=27923806 |pmc=5147536 |doi=10.1161/CIRCHEARTFAILURE.116.003415 |url=}}</ref><ref name="GarciaLabropoulos2018">{{cite journal|last1=Garcia|first1=Raudel|last2=Labropoulos|first2=Nicos|title=Duplex Ultrasound for the Diagnosis of Acute and Chronic Venous Diseases|journal=Surgical Clinics of North America|volume=98|issue=2|year=2018|pages=201–218|issn=00396109|doi=10.1016/j.suc.2017.11.007}}</ref><ref name="ChavhanAmaral2017">{{cite journal|last1=Chavhan|first1=Govind B.|last2=Amaral|first2=Joao G.|last3=Temple|first3=Michael|last4=Itkin|first4=Maxim|title=MR Lymphangiography in Children: Technique and Potential Applications|journal=RadioGraphics|volume=37|issue=6|year=2017|pages=1775–1790|issn=0271-5333|doi=10.1148/rg.2017170014}}</ref><ref name="HadjisCarr1985">{{cite journal|last1=Hadjis|first1=NS|last2=Carr|first2=DH|last3=Banks|first3=L|last4=Pflug|first4=JJ|title=The role of CT in the diagnosis of primary lymphedema of the lower limb|journal=American Journal of Roentgenology|volume=144|issue=2|year=1985|pages=361–364|issn=0361-803X|doi=10.2214/ajr.144.2.361}}</ref>
Shown below is an algorithm summarizing the diagnosis of <nowiki>edema</nowiki>.<ref name="pmid25657974">{{cite journal |vauthors=Joob B, Wiwanitkit V |title=Acute bilateral leg edema due to levofloxacin |journal=J Family Med Prim Care |volume=3 |issue=4 |pages=475–6 |date=2014 |pmid=25657974 |pmc=4311373 |doi=10.4103/2249-4863.148158 |url=}}</ref><ref name="pmid23251178">{{cite journal |vauthors=Hosseini SH, Ahmadi A |title=Peripheral Edema Occurring during Treatment with Risperidone Combined with Citalopram |journal=Case Rep Med |volume=2012 |issue= |pages=540732 |date=2012 |pmid=23251178 |pmc=3510775 |doi=10.1155/2012/540732 |url=}}</ref><ref name="pmid15675326">{{cite journal |vauthors=Kaizu K, Abe M |title=[Drug-induced edema] |language=Japanese |journal=Nippon Rinsho |volume=63 |issue=1 |pages=102–6 |date=January 2005 |pmid=15675326 |doi= |url=}}</ref><ref name="pmid17433897">{{cite journal |vauthors=Cushman M |title=Epidemiology and risk factors for venous thrombosis |journal=Semin. Hematol. |volume=44 |issue=2 |pages=62–9 |date=April 2007 |pmid=17433897 |pmc=2020806 |doi=10.1053/j.seminhematol.2007.02.004 |url=}}</ref><ref name="pmid28878840">{{cite journal |vauthors=Spiridon M, Corduneanu D |title=Chronic Venous Insufficiency: a Frequently Underdiagnosed and Undertreated Pathology |journal=Maedica (Buchar) |volume=12 |issue=1 |pages=59–61 |date=January 2017 |pmid=28878840 |pmc=5574075 |doi= |url=}}</ref><ref name="pmid7603138">{{cite journal |vauthors=Dupas B, el Kouri D, Curtet C, Peltier P, de Faucal P, Planchon B, Lejeune JJ |title=Angiomagnetic resonance imaging of iliofemorocaval venous thrombosis |journal=Lancet |volume=346 |issue=8966 |pages=17–9 |date=July 1995 |pmid=7603138 |doi=10.1016/s0140-6736(95)92650-x |url=}}</ref><ref name="Kataoka2013">{{cite journal|last1=Kataoka|first1=Hajime|title=Clinical Characteristics of Lower-Extremity Edema in Stage A Cardiovascular Disease Status Defined by the ACC/AHA 2001 Chronic Heart Failure Guidelines|journal=Clinical Cardiology|volume=36|issue=9|year=2013|pages=555–559|issn=01609289|doi=10.1002/clc.22159}}</ref><ref name="pmid27923806">{{cite journal |vauthors=Yeboah J, Bertoni A, Qureshi W, Aggarwal S, Lima JA, Kawel-Boehm N, Bluemke DA, Shah SJ |title=Pedal Edema as an Indicator of Early Heart Failure in the Community: Prevalence and Associations With Cardiac Structure/Function and Natriuretic Peptides (MESA [Multiethnic Study of Atherosclerosis]) |journal=Circ Heart Fail |volume=9 |issue=12 |pages= |date=December 2016 |pmid=27923806 |pmc=5147536 |doi=10.1161/CIRCHEARTFAILURE.116.003415 |url=}}</ref><ref name="GarciaLabropoulos2018">{{cite journal|last1=Garcia|first1=Raudel|last2=Labropoulos|first2=Nicos|title=Duplex Ultrasound for the Diagnosis of Acute and Chronic Venous Diseases|journal=Surgical Clinics of North America|volume=98|issue=2|year=2018|pages=201–218|issn=00396109|doi=10.1016/j.suc.2017.11.007}}</ref><ref name="ChavhanAmaral2017">{{cite journal|last1=Chavhan|first1=Govind B.|last2=Amaral|first2=Joao G.|last3=Temple|first3=Michael|last4=Itkin|first4=Maxim|title=MR Lymphangiography in Children: Technique and Potential Applications|journal=RadioGraphics|volume=37|issue=6|year=2017|pages=1775–1790|issn=0271-5333|doi=10.1148/rg.2017170014}}</ref><ref name="HadjisCarr1985">{{cite journal|last1=Hadjis|first1=NS|last2=Carr|first2=DH|last3=Banks|first3=L|last4=Pflug|first4=JJ|title=The role of CT in the diagnosis of primary lymphedema of the lower limb|journal=American Journal of Roentgenology|volume=144|issue=2|year=1985|pages=361–364|issn=0361-803X|doi=10.2214/ajr.144.2.361}}</ref><ref name="ZarnyBernstein1995">{{cite journal|last1=Zarny|first1=L.A.|last2=Bernstein|first2=L.H.|title=Serum Cholesterol:|journal=Journal of the American Dietetic Association|volume=95|issue=9|year=1995|pages=A25|issn=00028223|doi=10.1016/S0002-8223(95)00436-X}}</ref><ref name="PricePlatz2017">{{cite journal|last1=Price|first1=Susanna|last2=Platz|first2=Elke|last3=Cullen|first3=Louise|last4=Tavazzi|first4=Guido|last5=Christ|first5=Michael|last6=Cowie|first6=Martin R.|last7=Maisel|first7=Alan S.|last8=Masip|first8=Josep|last9=Miro|first9=Oscar|last10=McMurray|first10=John J.|last11=Peacock|first11=W. Frank|last12=Martin-Sanchez|first12=F. Javier|last13=Di Somma|first13=Salvatore|last14=Bueno|first14=Hector|last15=Zeymer|first15=Uwe|last16=Mueller|first16=Christian|title=Echocardiography and lung ultrasonography for the assessment and management of acute heart failure|journal=Nature Reviews Cardiology|volume=14|issue=7|year=2017|pages=427–440|issn=1759-5002|doi=10.1038/nrcardio.2017.56}}</ref><ref name="Tiwari2003">{{cite journal|last1=Tiwari|first1=Alok|title=Differential Diagnosis, Investigation, and Current Treatment of Lower Limb Lymphedema|journal=Archives of Surgery|volume=138|issue=2|year=2003|pages=152|issn=0004-0010|doi=10.1001/archsurg.138.2.152}}</ref>
 
 
 




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{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | A01 | | |||||||||||||||||||||||A01=Associated [[injury]]/illness}}
{{familytree | | | | | | | | | | | | | | A01 | | |||||||||||||||||||||||A01=Associated [[injury]]/illness}}
{{familytree | | | | | | | | | | B01 |-|.|!|,|-| B02 | | | | | | | |||||||||||||B01= Recent [[surgery]]/procedure|B02= [[Malygnancy]]}}
{{familytree | | | | | | | | | | B01 |-|.|!|,|-| B02 | | | | | | | |||||||||||||B01= Recent [[surgery]]/procedure|B02= [[Malignancy]]}}
{{familytree | | | | | | C01 |-|-|-|-|-| C02 |-|-|-|-|-| C03 | | | |||||||||||C01= Painful|C02= [[Clinical history]]|C03= Onset (acute,chronic)}}
{{familytree | | | | | | C01 |-|-|-|-|-| C02 |-|-|-|-|-| C03 | | | |||||||||||C01= Painful|C02= [[Clinical history]]|C03= Onset (acute,chronic)}}
{{familytree | | | | | | | | | | D01 |-|'|!|`|-| D02 | | | | | | | ||||||||||D01= Aggravated by activity|D02= Systemic diseases}}
{{familytree | | | | | | | | | | D01 |-|'|!|`|-| D02 | | | | | | | ||||||||||D01= Aggravated by activity|D02= Systemic diseases}}
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{{familytree/end}}
{{familytree/end}}
   
   
{{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}}
 
{{Family tree/start}}
{{familytree  | | | | | B01 | | | | | B01=<div style="float: left; text-align: left; height: 45em; width: 25em; padding:1em;"> '''Diagnostic tools:'''<br>
:❑ [[Duplex sonography]] in patients with unilateral lower limb swelling and positive [[D-dimer]] or high clinical suspicion for [[thrombosis]]
:❑ Abdominal or [[pelvic CT scan]] in patients with [[lower limb swelling]] and evidence of [[malygnancy]]
:❑ [[Magnetic resonance venography]] of the lower leg in patients with unilateral [[leg swelling]] without evidence of [[thrombosis]] on [[duplex ultrasonography]] if there is high clinical suspicion for [[deep venous thrombosis]]
:❑ [[Echocardiography]] in patients with  [[obesity]], [[obstructive sleep apnea]], and [[edema]] for  evaluation of [[pulmonary arterial pressures]] and also in patients with evidence of[[ heart failure]] for assessment of [[ejection fraction]] and [[pulmonary artery pressure]] and [[structural heart disease]]. 
:❑ [[Ankle-brachial index]] in patients with [[chronic venous insufficiency]] and [[cardiovascular risk factors]] before compression therapy in suspicion of [[peripheral arterial disease]]
:❑ [[Lymphoscintigraphy]] and [[magnetic resonance lymphangiography]] in patients with [[lymphedema]]}}
{{familytree/end}}
{{familytree/end}}
<br>
<br>
{{familytree/start |summary=Sample 6}}
{{familytree/start |summary=Sample 6}}
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{{familytree| | | | C01 | | | | | | C02 | | | | C03 | | | | C01=[[JVP]] estimation|C02=[[Unilateral edema]]|C03=[[Bilateral edema]]}}
{{familytree| | | | C01 | | | | | | C02 | | | | C03 | | | | C01=[[JVP]] estimation|C02=[[Unilateral edema]]|C03=[[Bilateral edema]]}}
{{familytree| | |,|-|^|-|.| | | | | |!| | | |,|-|^|-|.| | | }}
{{familytree| | |,|-|^|-|.| | | | | |!| | | |,|-|^|-|.| | | }}
{{familytree| | |D01| |D02| | | | D03 | |D04  | | D05 | | | | D01=Normal|D02=Prominent|D03=[[Acute DVT]], [[cellulitis]], [[chronic venous insufficiency]], [[lymphedema]], [[tumor]], [[baker cyst]], [[trauma]] [[compartment syndrome]], [[hematoma]], [[complex regional pain syndrome]], [[popliteal aneurysm]], [[dependency]]|D04=Non pitting, non tender|D05=Pitting, tender|}}
{{familytree| | |D01| |D02| | | | D03 | |D04  | | D05 | | | | D01=Normal|D02=Prominent|D03= Acute [[DVT]], [[cellulitis]], [[chronic venous insufficiency]], [[lymphedema]], [[tumor]], [[baker cyst]], [[trauma]] [[compartment syndrome]], [[hematoma]], [[complex regional pain syndrome]], [[popliteal aneurysm]], [[dependency]]|D04=Non pitting, non tender|D05=Pitting, tender|}}
{{familytree| | |!| | | |!| | | | | | | | | |!| | | |!| | | | | |}}
{{familytree| | |!| | | |!| | | | | | | | | |!| | | |!| | | | | |}}
{{familytree| | |!| | | |!| | | | | | | | | |E04| |E05| | | | | | | | |E04=[[Lymphedema]]|E05=[[Chronic venous insufficiency]], systemic illnesses |}}
{{familytree| | |!| | | |!| | | | | | | | | |E04| |E05| | | | | | | | |E04=[[Lymphedema]]|E05=[[Chronic venous insufficiency]], systemic illnesses |}}
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:❑ Abdominal or [[pelvic CT scan]] in patients with [[lower limb swelling]] and evidence of [[malygnancy]]
:❑ Abdominal or [[pelvic CT scan]] in patients with [[lower limb swelling]] and evidence of [[malygnancy]]
:❑ [[Magnetic resonance venography]] of the lower leg in patients with unilateral [[leg swelling]] without evidence of [[thrombosis]] on [[duplex ultrasonography]] if there is high clinical suspicion for [[deep venous thrombosis]]
:❑ [[Magnetic resonance venography]] of the lower leg in patients with unilateral [[leg swelling]] without evidence of [[thrombosis]] on [[duplex ultrasonography]] if there is high clinical suspicion for [[deep venous thrombosis]]
:❑ [[Echocardiography]] in patients with  [[obesity]], [[obstructive sleep apnea]], and [[edema]] for  evaluation of [[pulmonary arterial pressures]] and also in patients with evidence of[[ heart failure]] for assessment of [[ejection fraction]] and [[pulmonary artery pressure]] and [[structural heart disease]].   
:❑ [[Echocardiography]] in patients with  [[obesity]], [[obstructive sleep apnea]], and [[edema]] for  evaluation of [[pulmonary arterial pressures]] and also in patients with evidence of [[ heart failure]] for assessment of [[ejection fraction]] and [[pulmonary artery pressure]] and [[structural heart disease]].   
:❑ [[Ankle-brachial index]] in patients with [[chronic venous insufficiency]] and [[cardiovascular risk factors]] before compression therapy in suspicion of [[peripheral arterial disease]]
:❑ [[Ankle-brachial index]] in patients with [[chronic venous insufficiency]] and [[cardiovascular risk factors]] before compression therapy in suspicion of [[peripheral arterial disease]]
:❑ [[Lymphoscintigraphy]] and [[magnetic resonance lymphangiography]] in patients with [[lymphedema]]}}
:❑ [[Lymphoscintigraphy]] and [[magnetic resonance lymphangiography]] in patients with [[lymphedema]]}}
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{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=[[Nephrotic syndrome]] |B02= Loop diuretic }}
{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=[[Nephrotic syndrome]] |B02= Loop diuretic }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | C01 |-|+|-| C02 |-| C03 | | |C01=[[Edema]] Treatment |C02=[[Lymphedema]] |C03= [[Compression stocking]], [[topical steroid]] (if there's an inflammatory etiology for the development of [[lymphedema]]), [[manual lymphatic dranage]], bandage}}
{{familytree | | | | | | C01 |-|+|-| C02 |-| C03 | | |C01=[[Edema]] Treatment |C02=[[Lymphedema]] |C03= [[Compression stocking]], [[topical steroid]] , [[manual lymphatic dranage]], bandage}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=[[Chronic venous insufficiency]] |D02= [[Compression stocking]], bandage, topical [[steroids]], venoactive drugs such as [[daflon]]}}
{{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=[[Chronic venous insufficiency]] |D02= [[Compression stocking]], bandage, topical [[steroids]], venoactive drugs such as [[daflon]]}}
Line 256: Line 249:
* After harvesting of [[leg vein]] for [[ bypass graft surgery]], mild compression stocking about 15-20 mmHg, reduced [[leg edema]] significantly.<ref name="pmid25478535">{{cite journal |vauthors=Alizadeh-Ghavidel A, Ramezannejad P, Mirmesdagh Y, Sadeghpour-Tabaei A |title=Prevention of edema after coronary artery bypass graft surgery by compression stockings |journal=Res Cardiovasc Med |volume=3 |issue=2 |pages=e17463 |date=May 2014 |pmid=25478535 |pmc=4253792 |doi=10.5812/cardiovascmed.17463 |url=}}</ref> <ref name="Maleti2016">{{cite journal|last1=Maleti|first1=Oscar|title=Compression after vein harvesting for coronary bypass|journal=Veins and Lymphatics|volume=5|issue=1|year=2016|issn=2279-7483|doi=10.4081/vl.2016.5989}}</ref>
* After harvesting of [[leg vein]] for [[ bypass graft surgery]], mild compression stocking about 15-20 mmHg, reduced [[leg edema]] significantly.<ref name="pmid25478535">{{cite journal |vauthors=Alizadeh-Ghavidel A, Ramezannejad P, Mirmesdagh Y, Sadeghpour-Tabaei A |title=Prevention of edema after coronary artery bypass graft surgery by compression stockings |journal=Res Cardiovasc Med |volume=3 |issue=2 |pages=e17463 |date=May 2014 |pmid=25478535 |pmc=4253792 |doi=10.5812/cardiovascmed.17463 |url=}}</ref> <ref name="Maleti2016">{{cite journal|last1=Maleti|first1=Oscar|title=Compression after vein harvesting for coronary bypass|journal=Veins and Lymphatics|volume=5|issue=1|year=2016|issn=2279-7483|doi=10.4081/vl.2016.5989}}</ref>
* [[Daflon]] or micronized purified flavonoid fraction (MPFF) is recommended in [[chronic venous insufficiency]] because of [[anti-inflammatory effect]] and enhancement of  [[venous contractility]].<ref name="pmid29874834">{{cite journal |vauthors=Mansilha A, Sousa J |title=Pathophysiological Mechanisms of Chronic Venous Disease and Implications for Venoactive Drug Therapy |journal=Int J Mol Sci |volume=19 |issue=6 |pages= |date=June 2018 |pmid=29874834 |pmc=6032391 |doi=10.3390/ijms19061669 |url=}}</ref>
* [[Daflon]] or micronized purified flavonoid fraction (MPFF) is recommended in [[chronic venous insufficiency]] because of [[anti-inflammatory effect]] and enhancement of  [[venous contractility]].<ref name="pmid29874834">{{cite journal |vauthors=Mansilha A, Sousa J |title=Pathophysiological Mechanisms of Chronic Venous Disease and Implications for Venoactive Drug Therapy |journal=Int J Mol Sci |volume=19 |issue=6 |pages= |date=June 2018 |pmid=29874834 |pmc=6032391 |doi=10.3390/ijms19061669 |url=}}</ref>
*
*Topical [[steroid]] maybe useful in stasis dermatitis ([[scaling]], [[erythematous skin changes]]) due to [[chronic venous insufficiency]] and [[lymphedema]].<ref name="Thomas Hess2011">{{cite journal|last1=Thomas Hess|first1=Cathy|title=Venous Dermatitis Checklist|journal=Advances in Skin & Wound Care|volume=24|issue=2|year=2011|pages=96|issn=1527-7941|doi=10.1097/01.ASW.0000394035.87647.38}}</ref>


== Dont's ==
== Dont's ==

Latest revision as of 14:10, 28 December 2021

Edema Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2]


Synonyms and keywords: Generalized edema, localized edema, unilateral edema, bilateral edema

Overview

Edema is an abnormal collection of fluid in interstitial space because of increased hydrostatic pressure, decreased oncotic pressure, increased capillary permeability, and obstruction in lymphatic drainage. Edema may be due to underlying systemic diseases such as nephrotic syndrome, right sided heart failure, hypothyroidism, hyperthyroidism, side effect of some drugs, complications of recent surgery and malignancy. Edema may be generalized due to cardiac, thyroid, kidney diseases or localized due to cellulitis, deep vein thrombosis (DVT), chronic venous insufficiency and lymphedema. Diagnosis is based on taking history of recent surgery, trauma, systemic illness, malignancy and doing physical examination about the distribution of edema and determination of pitting or non pitting edema, inducing pain on palpation. Duplex sonography is helpful for finding the evidence of DVT. For more investigation about localized edema with unknown etiology, abdominal computer tomography, magnetic resonance venography maybe required.

Causes

Life Threatening Causes of peripheral edema

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes of peripheral edema

Diagnosis

Shown below is an algorithm summarizing the diagnosis of edema.[11][12][13][14][15][16][17][2][18][19][20][21][22][23]





 
 
 
 
 
 
 
 
 
 
 
 
 
Associated injury/illness
 
 
 
 
 
 
 
 
 
 
 
Recent surgery/procedure
 
 
 
 
 
 
 
 
Malignancy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Painful
 
 
 
 
 
Clinical history
 
 
 
 
 
Onset (acute,chronic)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Aggravated by activity
 
 
 
 
 
 
 
 
Systemic diseases
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Changing in medications
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


 
 
 
 
 
 
 
 
 
 
 
 
 
Pulse examination
 
 
 
 
 
 
 
 
 
 
 
Ulcer
 
 
 
 
 
 
 
 
Lymphadenopathy/masses
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pitting
 
 
 
 
 
Physical examination
 
 
 
 
 
Unilateral/bilateral
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Skin texture, color
 
 
 
 
 
 
 
 
Distribution
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Temperature
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 



 
 
 
 
 
 
 
 
Edema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Generalized
 
 
 
 
 
 
 
Localized
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
JVP estimation
 
 
 
 
 
Unilateral edema
 
 
 
Bilateral edema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal
 
Prominent
 
 
 
Acute DVT, cellulitis, chronic venous insufficiency, lymphedema, tumor, baker cyst, trauma compartment syndrome, hematoma, complex regional pain syndrome, popliteal aneurysm, dependency
 
Non pitting, non tender
 
Pitting, tender
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lymphedema
 
Chronic venous insufficiency, systemic illnesses
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal cardiac size
 
 
 
Cardiomegaly
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pulmonary evaluation for pulmonary hypertension or cor pulmonale
 
 
 
Echocardiography
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Serum albumin
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal albumin
 
 
Decreased albumin
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Thyroid function test
 
 
Urinary protein
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
24 hours proteinuria <3.5 gram
 
 
24 hours proteinuria >3.5 gram
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal urinary sediment
 
 
Nephrotic syndrome
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Liver function test
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal
 
Abnormal
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Prealbumin, cholesterol level
 
Evaluation for liver disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Prealbumin<20 mg/dl, low cholesterol
 
Malnutrition
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Prealbumin>20 mg/dl
 
Capillary leak, protein losing entropathy, abnormal protein synthesis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


 
 
 
 
 
 
 
 
 
 
 
 
Heart failure
 
Increased capillary hydrostatic pressure from systemic venous hypertension, volume overload
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hepatic disease
 
Increased capillary hydrostatic pressure from systemic venous hypertension, decreased oncotic pressure from reduced protein synthesis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mechanism of Edema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chronic venous insufficiency
 
Increased capillary hydrostatic pressure due to venous hypertension, venous reflux, poorly functioning venous valves, incompetent venous valves, reduced venous return, blood pooling, hypoxia, and inflammation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lymphedema
 
Lymphatic obstruction, lymph node dissection, malignancy, filariasis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cellulitis
 
Increased capillary permeability
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Obstructive sleep apnea
 
Increased capillary hydrostatic pressure due to pulmonary hypertension
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Renal disease
 
Increased capillary hydrostatic pressure and plasma volume, decreased plasma oncotic pressure from protein loss
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Protein losing entropathy
 
Decreased plasma oncotic pressure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Deep vein thrombosis
 
Increased capillary hydrostatic pressure due to venous obstruction
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cellulitis
 
Increased capillary permeability
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pregnancy
 
Increased capillary hydrostatic pressure, increased plasma volume
 
 
 
 
 
 


 
 
 
 
 
 
 
 


 
 
 
 
 
 
 
 




 
 
 
 
Diagnostic tools:
❑ Duplex sonography in patients with unilateral lower limb swelling and positive D-dimer or high clinical suspicion for thrombosis
❑ Abdominal or pelvic CT scan in patients with lower limb swelling and evidence of malygnancy
❑ Magnetic resonance venography of the lower leg in patients with unilateral leg swelling without evidence of thrombosis on duplex ultrasonography if there is high clinical suspicion for deep venous thrombosis
❑ Echocardiography in patients with obesity, obstructive sleep apnea, and edema for evaluation of pulmonary arterial pressures and also in patients with evidence of heart failure for assessment of ejection fraction and pulmonary artery pressure and structural heart disease.
❑ Ankle-brachial index in patients with chronic venous insufficiency and cardiovascular risk factors before compression therapy in suspicion of peripheral arterial disease
❑ Lymphoscintigraphy and magnetic resonance lymphangiography in patients with lymphedema
 
 
 
 


Treatment

Shown below is an algorithm summarizing the treatment of edema.[24][25][26][1][27][28][29][30]

 
 
 
 
 
 
 
 
 
 
 
 
Congestive heart failure
 
Loop diuretic, sodium restriction, compression stocking
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Nephrotic syndrome
 
Loop diuretic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Edema Treatment
 
 
 
 
Lymphedema
 
Compression stocking, topical steroid , manual lymphatic dranage, bandage
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chronic venous insufficiency
 
Compression stocking, bandage, topical steroids, venoactive drugs such as daflon
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Deep vein thrombosis
 
Anticoagulant therapy, early walking, compression stocking
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cellulitis
 
Antibiotic therapy, compression stocking
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pregnancy
 
External pneumatic compression, compression stockings
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lipedema
 
Suction lipectomy
 
 
 
 
 
 

Do's

Dont's

References

  1. ↑ 1.0 1.1 Gupta S, Pepper RJ, Ashman N, Walsh SB (2018). "Nephrotic Syndrome: Oedema Formation and Its Treatment With Diuretics". Front Physiol. 9: 1868. doi:10.3389/fphys.2018.01868. PMC 6341062. PMID 30697163.
  2. ↑ 2.0 2.1 Yeboah J, Bertoni A, Qureshi W, Aggarwal S, Lima JA, Kawel-Boehm N, Bluemke DA, Shah SJ (December 2016). "Pedal Edema as an Indicator of Early Heart Failure in the Community: Prevalence and Associations With Cardiac Structure/Function and Natriuretic Peptides (MESA [Multiethnic Study of Atherosclerosis])". Circ Heart Fail. 9 (12). doi:10.1161/CIRCHEARTFAILURE.116.003415. PMC 5147536. PMID 27923806.
  3. ↑ Spodick, D H (1992). "Pathogenesis of edema in constrictive pericarditis". Circulation. 85 (2): 848–848. doi:10.1161/01.CIR.85.2.848. ISSN 0009-7322.
  4. ↑ Shapiro S, Pollock DM, Gillies H, Henig N, Allard M, Blair C, Anglen C, Kohan DE (November 2012). "Frequency of edema in patients with pulmonary arterial hypertension receiving ambrisentan". Am. J. Cardiol. 110 (9): 1373–7. doi:10.1016/j.amjcard.2012.06.040. PMC 4167616. PMID 22858181.
  5. ↑ Anand IS, Chandrashekhar Y, Ferrari R, Poole-Wilson PA, Harris PC (October 1993). "Pathogenesis of oedema in chronic severe anaemia: studies of body water and sodium, renal function, haemodynamic variables, and plasma hormones". Br Heart J. 70 (4): 357–62. doi:10.1136/hrt.70.4.357. PMC 1025332. PMID 8217445.
  6. ↑ Borman P (September 2018). "Lymphedema diagnosis, treatment, and follow-up from the view point of physical medicine and rehabilitation specialists". Turk J Phys Med Rehabil. 64 (3): 179–197. doi:10.5606/tftrd.2018.3539. PMC 6657795 Check |pmc= value (help). PMID 31453511.
  7. ↑ Bamigboye, Anthony Akinloye; Hofmeyr, George Justus (2006). "Interventions for leg edema and varicosities in pregnancy". European Journal of Obstetrics & Gynecology and Reproductive Biology. 129 (1): 3–8. doi:10.1016/j.ejogrb.2006.03.008. ISSN 0301-2115.
  8. ↑ Volke V, Matjus S (August 2012). "Unilateral pitting edema of the leg as a manifestation of Graves' disease: a case report". J Med Case Rep. 6: 258. doi:10.1186/1752-1947-6-258. PMC 3443661. PMID 22935075.
  9. ↑ Kazama I, Mori Y, Baba A, Nakajima T (2014). "Pitting type of pretibial edema in a patient with silent thyroiditis successfully treated by angiotensin ii receptor blockade". Am J Case Rep. 15: 111–4. doi:10.12659/AJCR.889854. PMC 3962324. PMID 24665353.
  10. ↑ 10.0 10.1 Blankfield, Robert P.; Hudgel, David W.; Tapolyai, Amy Artim; Zyzanski, Stephen J. (2000). "Bilateral Leg Edema, Obesity, Pulmonary Hypertension, and Obstructive Sleep Apnea". Archives of Internal Medicine. 160 (15): 2357. doi:10.1001/archinte.160.15.2357. ISSN 0003-9926.
  11. ↑ Joob B, Wiwanitkit V (2014). "Acute bilateral leg edema due to levofloxacin". J Family Med Prim Care. 3 (4): 475–6. doi:10.4103/2249-4863.148158. PMC 4311373. PMID 25657974.
  12. ↑ Hosseini SH, Ahmadi A (2012). "Peripheral Edema Occurring during Treatment with Risperidone Combined with Citalopram". Case Rep Med. 2012: 540732. doi:10.1155/2012/540732. PMC 3510775. PMID 23251178.
  13. ↑ Kaizu K, Abe M (January 2005). "[Drug-induced edema]". Nippon Rinsho (in Japanese). 63 (1): 102–6. PMID 15675326.
  14. ↑ Cushman M (April 2007). "Epidemiology and risk factors for venous thrombosis". Semin. Hematol. 44 (2): 62–9. doi:10.1053/j.seminhematol.2007.02.004. PMC 2020806. PMID 17433897.
  15. ↑ Spiridon M, Corduneanu D (January 2017). "Chronic Venous Insufficiency: a Frequently Underdiagnosed and Undertreated Pathology". Maedica (Buchar). 12 (1): 59–61. PMC 5574075. PMID 28878840.
  16. ↑ Dupas B, el Kouri D, Curtet C, Peltier P, de Faucal P, Planchon B, Lejeune JJ (July 1995). "Angiomagnetic resonance imaging of iliofemorocaval venous thrombosis". Lancet. 346 (8966): 17–9. doi:10.1016/s0140-6736(95)92650-x. PMID 7603138.
  17. ↑ Kataoka, Hajime (2013). "Clinical Characteristics of Lower-Extremity Edema in Stage A Cardiovascular Disease Status Defined by the ACC/AHA 2001 Chronic Heart Failure Guidelines". Clinical Cardiology. 36 (9): 555–559. doi:10.1002/clc.22159. ISSN 0160-9289.
  18. ↑ Garcia, Raudel; Labropoulos, Nicos (2018). "Duplex Ultrasound for the Diagnosis of Acute and Chronic Venous Diseases". Surgical Clinics of North America. 98 (2): 201–218. doi:10.1016/j.suc.2017.11.007. ISSN 0039-6109.
  19. ↑ Chavhan, Govind B.; Amaral, Joao G.; Temple, Michael; Itkin, Maxim (2017). "MR Lymphangiography in Children: Technique and Potential Applications". RadioGraphics. 37 (6): 1775–1790. doi:10.1148/rg.2017170014. ISSN 0271-5333.
  20. ↑ Hadjis, NS; Carr, DH; Banks, L; Pflug, JJ (1985). "The role of CT in the diagnosis of primary lymphedema of the lower limb". American Journal of Roentgenology. 144 (2): 361–364. doi:10.2214/ajr.144.2.361. ISSN 0361-803X.
  21. ↑ Zarny, L.A.; Bernstein, L.H. (1995). "Serum Cholesterol:". Journal of the American Dietetic Association. 95 (9): A25. doi:10.1016/S0002-8223(95)00436-X. ISSN 0002-8223.
  22. ↑ Price, Susanna; Platz, Elke; Cullen, Louise; Tavazzi, Guido; Christ, Michael; Cowie, Martin R.; Maisel, Alan S.; Masip, Josep; Miro, Oscar; McMurray, John J.; Peacock, W. Frank; Martin-Sanchez, F. Javier; Di Somma, Salvatore; Bueno, Hector; Zeymer, Uwe; Mueller, Christian (2017). "Echocardiography and lung ultrasonography for the assessment and management of acute heart failure". Nature Reviews Cardiology. 14 (7): 427–440. doi:10.1038/nrcardio.2017.56. ISSN 1759-5002.
  23. ↑ Tiwari, Alok (2003). "Differential Diagnosis, Investigation, and Current Treatment of Lower Limb Lymphedema". Archives of Surgery. 138 (2): 152. doi:10.1001/archsurg.138.2.152. ISSN 0004-0010.
  24. ↑ Papadopoulou MC, Tsiouri I, Salta-Stankova R, Drakou A, Rousas N, Roussaki-Schulze AV, Giannoukas AD (March 2012). "Multidisciplinary lymphedema treatment program". Int J Low Extrem Wounds. 11 (1): 20–7. doi:10.1177/1534734612438436. PMID 22336900.
  25. ↑ 25.0 25.1 25.2 Urbanek, Tomasz; Juśko, Maciej; Kuczmik, Wacław B. (2020). "Compression therapy for leg oedema in patients with heart failure". ESC Heart Failure. doi:10.1002/ehf2.12848. ISSN 2055-5822.
  26. ↑ 26.0 26.1 Mansilha A, Sousa J (June 2018). "Pathophysiological Mechanisms of Chronic Venous Disease and Implications for Venoactive Drug Therapy". Int J Mol Sci. 19 (6). doi:10.3390/ijms19061669. PMC 6032391. PMID 29874834.
  27. ↑ 27.0 27.1 27.2 Partsch H, Blättler W (November 2000). "Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin". J. Vasc. Surg. 32 (5): 861–9. doi:10.1067/mva.2000.110352. PMID 11054217.
  28. ↑ Kayıran O, De La Cruz C, Tane K, Soran A (2017). "Lymphedema: From diagnosis to treatment". Turk J Surg. 33 (2): 51–57. doi:10.5152/turkjsurg.2017.3870. PMC 5508242. PMID 28740950.
  29. ↑ Sullivan T, de Barra E (March 2018). "Diagnosis and management of cellulitis". Clin Med (Lond). 18 (2): 160–163. doi:10.7861/clinmedicine.18-2-160. PMC 6303460. PMID 29626022.
  30. ↑ Warren Peled A, Kappos EA (2016). "Lipedema: diagnostic and management challenges". Int J Womens Health. 8: 389–95. doi:10.2147/IJWH.S106227. PMC 4986968. PMID 27570465.
  31. ↑ Ten Cate-Hoek AJ, Amin EE, Bouman AC, Meijer K, Tick LW, Middeldorp S, Mostard G, Ten Wolde M, van den Heiligenberg SM, van Wissen S, van de Poel MH, Villalta S, Serné EH, Otten HM, Klappe EH, Bistervels IM, Lauw MN, Piersma-Wichers M, Prandoni P, Joore MA, Prins MH, Ten Cate H (January 2018). "Individualised versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome (IDEAL DVT): a multicentre, randomised, single-blind, allocation-concealed, non-inferiority trial". Lancet Haematol. 5 (1): e25–e33. doi:10.1016/S2352-3026(17)30227-2. PMID 29217387. Vancouver style error: initials (help)
  32. ↑ 32.0 32.1 Aschwanden M, Labs KH, Engel H, Schwob A, Jeanneret C, Mueller-Brand J, Jaeger KA (January 2001). "Acute deep vein thrombosis: early mobilization does not increase the frequency of pulmonary embolism". Thromb. Haemost. 85 (1): 42–6. PMID 11204585.
  33. ↑ Roumen-Klappe EM, den Heijer M, van Rossum J, Wollersheim H, van der Vleuten C, Thien T, Janssen MC (May 2009). "Multilayer compression bandaging in the acute phase of deep-vein thrombosis has no effect on the development of the post-thrombotic syndrome". J. Thromb. Thrombolysis. 27 (4): 400–5. doi:10.1007/s11239-008-0229-7. PMID 18480967.
  34. ↑ Amin EE, Joore MA, Ten Cate H, Meijer K, Tick LW, Middeldorp S, Mostard G, Ten Wolde M, van den Heiligenberg SM, van Wissen S, van de Poel M, Villalta S, Serné EH, Otten HM, Klappe EH, Prandoni P, Ten Cate-Hoek AJ (June 2018). "Clinical and economic impact of compression in the acute phase of deep vein thrombosis". J. Thromb. Haemost. doi:10.1111/jth.14163. PMID 29856509. Vancouver style error: initials (help)
  35. ↑ . doi:10.3928/0147-7447-20001001-29. Missing or empty |title= (help)
  36. ↑ Usmani, N.; Baxter, K.F.; Sheehan-Dare, R. (2004). "Partially reversible common peroneal nerve palsy secondary to compression with four-layer bandaging in a chronic case of venous leg ulceration". British Journal of Dermatology. 150 (6): 1224–1225. doi:10.1111/j.1365-2133.2004.06010.x. ISSN 0007-0963.
  37. ↑ Alizadeh-Ghavidel A, Ramezannejad P, Mirmesdagh Y, Sadeghpour-Tabaei A (May 2014). "Prevention of edema after coronary artery bypass graft surgery by compression stockings". Res Cardiovasc Med. 3 (2): e17463. doi:10.5812/cardiovascmed.17463. PMC 4253792. PMID 25478535.
  38. ↑ Maleti, Oscar (2016). "Compression after vein harvesting for coronary bypass". Veins and Lymphatics. 5 (1). doi:10.4081/vl.2016.5989. ISSN 2279-7483.
  39. ↑ Thomas Hess, Cathy (2011). "Venous Dermatitis Checklist". Advances in Skin & Wound Care. 24 (2): 96. doi:10.1097/01.ASW.0000394035.87647.38. ISSN 1527-7941.
  40. ↑ . doi:10.1177/ 2F0268355520909066 Check |doi= value (help). Missing or empty |title= (help)


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