Evaluation of peripheral edema

Diseases

Summary

Peripheral edema is the presence of excess interstitial fluid in the tissue of the extremities, which causes palpable swelling.[1]

Edema develops when microvascular filtration, and therefore interstitial fluid production, exceeds lymph drainage for a sustained period. This could be because the microvascular filtration rate is high, lymph flow is low, or both.[2]

Image

The body has a number of homeostatic mechanisms that serve to maintain interstitial fluid balance, and these must be overwhelmed before fluid buildup becomes evident as peripheral edema. Clues generated by the history, physical examination, and targeted evaluation help to identify the factors affecting lymphatic drainage and microvascular filtration. In many patients, multiple factors contribute to the development of peripheral edema.

Peripheral edema is called lymphedema when it is predominantly caused by inadequate lymphatic drainage.

Library

Development of edema: an imbalance between the filtration of fluid from the bloodstream and drainage via the lymph system.
Deep vein thrombosis (DVT) of the right leg with associated swelling and redness
A clinical assessment scoring system
Atrophie blanche and hemosiderin deposition in a patient with chronic venous insufficiency
Approach to the patient with peripheral edema. DVT, deep vein thrombosis; HTN, hypertension
Extensive bilateral leg edema

Citations

Key Articles

Mortimer PS, Levick JR. Chronic peripheral oedema: the critical role of the lymphatic system. Clin Med (Lond). 2004 Sep-Oct;4(5):448-53.[Abstract][Full Text]
Mortimer PS, Rockson SG. New developments in clinical aspects of lymphatic disease. J Clin Invest. 2014 Mar;124(3):915-21.[Abstract][Full Text]
Executive Committee of the International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. Lymphology. 2020;53(1):3-19.[Abstract][Full Text]

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