Pedal edema

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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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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: M.Umer Tariq [2]

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. Edema is caused by an accumulation of an excessive amount of watery fluid in the serous cavities, tissues or cells causing painless, non-reddened swelling

Epidemiology and Demographics

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

Complete Differential Diagnosis of Pedal Edema

In alphabetical order: [1] [2]

Complete Differential Diagnosis of the Causes of Pedal Edema

(By organ system)

Cardiovascular

AV fistula, Constrictive pericarditis, Left heart failure, Myocardial Infarction, Right heart failure, Thoracic aneurysm, Thrombophlebitis, Thrombosis, Varicose veins,

Chemical / poisoning

Insect bite, Snakebites,

Dermatologic

Carbuncle, Cellulitis, Contact dermatitis, Contusion, Erysipelas, Gas gangrene,

Drug Side Effect ACE inhibitors, aceon, actos, aldomet, amiodarone, amlodipine, arixtra, atorvastatin, avandia, beta blockers, cardura, casodex, cilostazol, cisplatin, clopidogrel, coreg, crestor, diltiazem, docetaxel, estrogen, evista, flecainide, fondaparinux, glitazones, hydralazine, ibuprofen, labetalol, lipitor, minipress, minoxidil, motrin, nifedipine, norpace, norvasc, pindol, plendil, tenormin, trentinion, univasc valproic acid, verapamil, vesinoid, vytorin, xeloda


, axotereA,r omasinT,a xol, Tamoxifeann, dH ercept

Ear Nose Throat No underlying causes
Endocrine

Addison's Disease, Cushing's Syndrome, Hyperthyroidism, Hypothyroidism,

Environmental

Cold (physical stimuli), Frostbite, Sunburn,

Gastroenterologic

Exudative enteropathy, Liver failure, Malabsorption,


Genetic No underlying causes
Hematologic Anemia,

Hypoalbuminemia,

Iatrogenic No underlying causes
Infectious Disease

Filariasis, Trichinosis,

Musculoskeletal / Ortho

Fracture, Gout, Ligamentous sprain, Osteomyelitis,

Neurologic

Peripheral nerve lesion,

Nutritional / Metabolic

Acquired C1-esterase inhibitor deficiency, Beriberi, Malnutrition, Starvation edema,

Obstetric/Gynecologic

Amniotic band syndrome, Peripartum cardiomyopathy, Premenstrual edema,

Oncologic

Mediastinal cancer,

Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric

Anorexia Nervosa, Bulimia Nervosa,

Pulmonary

Pulmonary hypertension,

Renal / Electrolyte

Acute glomerulonephritis, Bartter's Syndrome, Nephrotic Syndrome,

Rheum / Immune / Allergy

Angioneurotic edema, Cachexia, Lymph node mass, Scleroderma, Sepsis syndrome,

Sexual No underlying causes
Trauma

Bruise, Burn, Musculoskeletal trauma,

Urologic No underlying causes
Miscellaneous

Idiopathic edema, Milroy's Disease, Sepsis syndrome, Tight clothing,

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)

Laboratory Findings

  • Labs include:

Chest X Ray

Echocardiography or Ultrasound

Other Diagnostic Studies

Treatment

Acute Pharmacotherapies

Chronic Pharmacotherapies

Indications for Surgery

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.

Acknowledgements

The content on this page was first contributed by: C. Michael Gibson, M.S., M.D.

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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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