Bilateral leg swelling

Background

Mechanisms of Pedal Edema

• Definition: existence of the excess fluid in the lower extremity resulting in swelling of the feet and extending upward
  • Further classified as pitting (depress-able) and non-pitting

Causes

• Increased hydrostatic pressure
• Decreased oncotic pressure
• Increased capillary permeability
• Lymphatic obstruction

Clinical Features

Pitting pedal edema

• Pedal edema

Differential Diagnosis

Differential Diagnosis of Pedal Edema

• Gravitational
• Venous insufufficiency/thrombophlebitis
• Drugs
  • NSAIDS
  • Birth control
  • Steroids
• CHF
• Lymphedema
• Pretibial myxedema

Evaluation

• CBC
• Chem 7
• PT vs albumin (liver)
• ECG
• CXR
• UA (nephrotic)

Management

• Address underlying disease process.
• Solitary pedal edema need not to be treated with diuretics.
• Always review medication list before discharging patients.

Disposition

• Most patients may be safely discharged home.
• Patients should be followed up in medical clinic for further investigation and care.

External Links

• DDxOf: Differential Diagnosis of Lower Extremity Edema