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 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 insufufficiency
- Thrombophlebitis
- Lymphedema
- Medications
- Deep venous thrombosis (uncomplicated)
- Leg or foot infection
- 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
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.[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
- Kay A, Davis CL. Idiopathic Edema. American Journal of Kidney Disease. 1999; 34(3): 405-408.
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