Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis the CaVenT study : a randomised controlled trial. Effect of renin-angiotensin system blockade on calcium channel blocker-associated peripheral edema. Peripheral edema associated with calcium channel blockers: incidence and withdrawal rate—a meta-analysis of randomized trials.
J Hypertens. Birklein F. Complex regional pain syndrome. J Neurol. Effect of nasal continuous positive airway pressure on edema in patients with obstructive sleep apnea. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.
Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Jul 15, Issue. Edema: Diagnosis and Management. Author disclosure: No relevant financial affiliations. C 22 , 23 Echocardiography should be performed in patients with obesity, obstructive sleep apnea, and edema to evaluate pulmonary arterial pressures. C 27 , 28 Ankle-brachial index should be measured in patients with chronic venous insufficiency and cardiovascular risk factors before initiation of compression therapy, which is contraindicated in peripheral arterial disease.
C 30 , 31 Daily hydration with emollients and short courses of topical steroid creams for severely inflamed skin should be used to treat eczematous stasis dermatitis associated with chronic venous insufficiency. C 36 Pneumatic compression devices should be used in conjunction with standard therapy in patients with lymphedema. C 11 , 39 , 40 Compression stockings should be used in patients following deep venous thrombosis to prevent postthrombotic syndrome.
Enlarge Print Table 1. Table 1. Enlarge Print Table 2. Table 2. Algorithm for the diagnosis of bilateral lower extremity edema or anasarca. Enlarge Print Table 3. Medications Commonly Associated with Edema Class Specific medications Antidepressants Monoamine oxidase inhibitors, trazodone Antihypertensives Beta-adrenergic blockers, calcium channel blockers, clonidine Catapres , hydralazine, methyldopa, minoxidil Antivirals Acyclovir Zovirax Chemotherapeutics Cyclophosphamide, cyclosporine Sandimmune , cytosine arabinoside, mithramycin Cytokines Granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, interferon alfa, interleukin-2, interleukin-4 Hormones Androgen, corticosteroids, estrogen, progesterone, testosterone Nonsteroidal anti- inflammatory drugs Celecoxib Celebrex , ibuprofen Information from references 1 through 5.
Table 3. Enlarge Print Figure 3. Figure 3. Enlarge Print Figure 4. Acute deep venous thrombosis with overlying cellulitis. Figure 4. Enlarge Print eFigure A. Enlarge Print Figure 5. Figure 5. Enlarge Print eFigure B. Enlarge Print eFigure C. Long-standing lymphedema with thickened, verrucous skin. Enlarge Print eFigure D. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue.
Purchase Access: See My Options close. Best Value! To see the full article, log in or purchase access. More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Navigate this Article. Allergic reaction, urticaria, and angioedema. Increased capillary permeability. Reduced protein synthesis leading to decreased plasma oncotic pressure. Obstructive sleep apnea. Pulmonary hypertension resulting in increased capillary hydrostatic pressure.
Pregnancy and premenstrual edema. Increased plasma volume. Increased plasma volume; decreased plasma oncotic pressure from protein loss. Increased capillary permeability caused by local venous hypertension. Complex regional pain syndrome type 1 reflex sympathetic dystrophy. Neurogenically mediated increased capillary permeability. Deep venous thrombosis. Iliac vein obstruction.
Accumulation of fluid in adipose tissue. Lymphatic obstruction. May-Thurner syndrome compression of left iliac vein by right iliac artery. Unilateral predominance. Onset: chronic; begins in middle to older age Location: lower extremities; bilateral distribution in later stages.
Duplex ultrasonography Ankle-brachial index to evaluate for arterial insufficiency. Compression stockings Pneumatic compression device if stockings are contraindicated Horse chestnut seed extract Skin care e. Onset: chronic; following trauma or other inciting event Location: upper or lower extremities; contralateral limb at risk regardless of trauma.
Soft tissue edema distal to affected limb Associated findings: early warm, tender skin with diaphoresis; late thin, shiny skin with atrophic changes. History and examination Radiography Three-phase bone scintigraphy Magnetic resonance imaging. Systemic steroids Topical dimethyl sulfoxide solution Physical therapy Tricyclic antidepressants Calcium channel blockers.
Onset: acute Location: upper or lower extremities. Anticoagulation therapy Compression stockings to prevent postthrombotic syndrome Thrombolysis in select patients. Early: dough-like skin; pitting Late: thickened, verrucous, fibrotic, hyperkeratotic skin Associated findings: inability to tent skin over second digit, swelling of dorsum of foot with squared off digits, painless heaviness in extremity. Clinical diagnosis Lymphoscintigraphy T1-weighted magnetic resonance lymphangiography. Complex decongestive physiotherapy Compression stockings with adjuvant pneumatic compression devices Skin care Surgery in limited cases.
Bilateral predominance. Onset: chronic; begins around or after puberty Location: predominantly lower extremities; involves thighs, legs, buttocks; spares feet, ankles, and upper torso.
Nonpitting edema; increased distribution of soft, adipose tissue Associated findings: medial thigh and tibial tenderness; fat pad anterior to lateral malleoli.
Clinical diagnosis. No effective treatment Weight loss does not improve edema. Medication-induced edema. Onset: weeks after initiation of medication; resolves within days of stopping offending medication Location: lower extremities. Soft, pitting edema. Cessation of medication. Onset: chronic Location: lower extremities. Mild, pitting edema Associated findings: daytime fatigue, snoring, obesity.
Suggestive clinical history Polysomnography Echocardiography. Positive pressure ventilation Treatment of pulmonary hypertension if suggested on echocardiography.
Monoamine oxidase inhibitors, trazodone. Cyclophosphamide, cyclosporine Sandimmune , cytosine arabinoside, mithramycin. Androgen, corticosteroids, estrogen, progesterone, testosterone. Nonsteroidal anti- inflammatory drugs. These are the most common classifications of edema and are easily identifiable. The biggest difference between pitting and non-pitting edema is the way the two conditions respond to pressure. Pitting edema responds to pressure, be it from a finger or a hand, while pitting edema does not.
If you press on your skin with your finger and it leaves an indentation, you could be suffering from pitting edema. Non-pitting edema, on the other hand, does not respond to pressure or cause any sort of indentation.
Follow along to learn more about pitting and non-pitting edema including causes, treatments, and more information. Pitting edema often affects areas of the lower body including the feet, legs, and ankles, but can occur anywhere on the body. Pitting edema can be a result of problems with the liver, kidneys, heart, or even the lymphatic system.
Regardless of where the pitting edema is occurring, it is a sign that your body is holding onto fluid or fluid is not being carried away as it should. If these symptoms apply to you, you should seek medical help immediately.
While pitting edema can usually be associated to a problem with the liver, kidneys, heart, or lymphatic system, there are many other causes that can result in pitting edema. Some of those various issues include:. Some of these medical conditions are not cause for concern. Pitting edema in pregnancy is more common than not; however, it can still be a cause for concern and should be mentioned to your doctor.
Certain medications that result in pitting edema should be reassessed by the prescribing doctor. Risk factors that are associated with pitting edema include: high sodium intake, emphysema, immobility, sedentary lifestyle, and more. See your doctor immediately if you experience:. If you've been sitting for a prolonged period, such as on a long flight, and you develop leg pain and swelling that won't go away, call your doctor. Persistent leg pain and swelling can indicate a blood clot deep in your vein deep vein thrombosis, or DVT.
Edema occurs when tiny blood vessels in your body capillaries leak fluid. The fluid builds up in surrounding tissues, leading to swelling. In some cases, however, edema may be a sign of a more serious underlying medical condition. Several diseases and conditions may cause edema, including:.
If you are pregnant, your body retains more sodium and water than usual due to the fluid needed by the fetus and placenta. This can increase your risk of developing edema.
A chronic illness — such as congestive heart failure or liver or kidney disease — can increase your risk of edema. Also, surgery can sometimes obstruct a lymph node, leading to swelling in an arm or leg, usually on just one side. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version.
0コメント