Unilateral leg swelling

Background

• 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

• Unilateral leg swelling

Differential Diagnosis

Unilateral leg swelling

Differential Diagnosis of Pedal Edema

• Gravitational
• Venous stasis
• Thrombophlebitis
• Lymphedema
• Medications
  • NSAIDS
  • Birth control
  • Steroids
• Deep venous thrombosis (uncomplicated)
  • Phlegmasia alba dolens
  • Phlegmasia cerulea dolens
• Leg or foot infection
  • Cellulitis
  • Necrotizing fasciitis
  • Septic Joint
• Fracture
• Compartment syndrome
• Limb hypertrophy
  • Hypertrophy of soft tissue or bone (Klippel-Trenaunay syndrome)
  • Overgrowth of body part (Proteus Syndrome)
• Lipedema
• Tumor
• Post-thrombotic Syndrome
• Causes of bilateral pedal edema
  • CHF
  • Pretibial myxedema
  • Renal failure
  • Liver failure
  • Hypoalbuminemia

Evaluation

• Ultrasound to rule-out DVT
• Consider x-rays

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

See Also

• Bilateral pedal edema

External Links

• DDxOf: Differential Diagnosis of Lower Extremity Edema