Bilateral leg swelling

Background

• Most common cause is bilaeral 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 of pedal edema

Mechanisms of Pedal Edema

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

Clinical Features

Pitting pedal edema

• Bilateral lower extremity swelling
  • Pitting = edema
  • Non-pitting ("woody") = consider pretibial myxedema

Differential Diagnosis

Bilateral leg swelling

Differential Diagnosis of Pedal Edema

• Pedal edema
  • Gravitational
  • Venous insufficiency
  • Thrombophlebitis
  • Drugs
    • NSAIDS
    • Birth control
    • Steroids
  • CHF
  • Lymphedema
  • Renal failure
  • Liver failure
  • Pregnancy
  • Heat edema
  • Idiopathic
• Other
  • DVT
  • Pretibial myxedema

Evaluation

Workup

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

Diagnosis

• Idiopathic edema is a diagnosis of exclusion, must first rule out CHF, cirrhosis, renal failure, nephrotic syndrome, chronic venous insufficiency, and medication-induced edema

Management

• Treatment is based on addressing underlying disease process
  • 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

See Also

• Unilateral leg swelling

External Links

• DDxOf: Differential Diagnosis of Lower Extremity Edema