Unilateral leg swelling

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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

Pedal edema

Differential Diagnosis of Pedal Edema

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.[1]
    • 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

External Links

References

  1. Kay A, Davis CL. Idiopathic Edema. American Journal of Kidney Disease. 1999; 34(3): 405-408.