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
• Renal failure
• Liver failure
• DVT

Evaluation

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

Management

• Treatment is based on addressing underlying disease process
• Idiopathic edema is a diagnosis of exclusion. Other disease process, including heart failure, cirrhosis, acute renal failure, nephrotic syndrome, chronic venous insufficiency, and medication induced edema must first be considered.
  • Idiopathic pedal edema need not to be treated with diuretics

Disposition

• If no respiratory symptoms, 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